Nautilus Marine Insurance Agency

Runabout Insurance Indicative Quote Request

All fields are required unless marked (optional)

Personal Details

Name:

Email:

State:

Postcode:

Phone:

Type of Cover

Type Of Cover

Comprehensive Third Party Only Other? Please specify:

Insured Details

Has the insured(s):

Ever had any insurance refused or cancelled?

Yes No

Had any boat or any theft claims in the last five years?

Yes No

Been convicted of any offence in the last five years?

Yes No

Runabout Details

Hull

Make:

Year of Const:

Length (ft/mtr):

Const. Material:

Max Speed (Knots or km/h):

Motor/s

Make:

Year:

Power/HP:

Inboard?

Rear Mount Mid Mount Other

Fuel?

Petrol Diesel Gas Other

Legal Liability

Select liability required:

$5,000,000 $10,000,000

Do you require water skiing legal liability cover?

Yes No

Boat Value

Total Sum Insured:

Optional Benefits

Lay Up (optional)

Number of months lay up required:

Postcode of lay-up address if different from the above:

Experience details

Insured Age

Boating Experience

Boating Courses?

Yes No

We will provide you with an indicative quote for the insurance of your boat.

Nautilus Marine Insurance Agency - Quote Request Form

Runabout Insurance Indicative Quote Request