Boat Insurance Claim Form

Boat Insurance Claim Form

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Insured Details		Insured Vessel Details		Loss/ Incident Details		Additional Details		Declaration

	Make and Model No.	Year built	Reg. No.	Date purchased
Description *

	Visibility	Water	Wind
Please specify *

	Make	Model	Reg. no.	Colour
Please specify *

	Make	Model	Reg. no.	Colour
Please specify *

Declaration
1. I/We declare that all the particulars stated above and statements made in support thereof are true and correct, that no information relevant to this claim has been withheld, that no other person(s) have an interest of any kind in the said property and that all conditions and stipulations of the policy have been complied with.
2. I/We hereby claim from the underwriters in respect of the loss, damage or accident described above and declare that the amount claimed is based on a true value at the time of the loss.
3. I/We understand that the underwriters or their representatives may make further investigations in respect of this claim and that I/we may be required to submit further information and/or documentation in the furtherance of our claim.
4. I/We acknowledge that I/We have read and agree to the privacy consent and authorisation documented at Privacy Notices.
Signature *
N/A

E-Signature Field
Clear
Name
N/A

Required First Required Last
Date Signed *
N/A

dd/MM/yyyy
When this form is completed and SUBMIT is hit below, a copy of this form will be sent to the email address (claims@insurancespecialists.com.au) and also to the email address in the Insured Details section as a Word Document and PDF.

These documents can be sent to both client and insurer.
Important Notices *
N/A
Duty of Disclosure
In accordance with the provisions of the Insurance Contracts Act 1984 (Cth), you and everyone who is an insured under your policy and/or everyone who arranges insurance on behalf of a business entity and/or body corporate, must comply with the Duty of Disclosure. Make sure that you explain the duty to any other insureds you apply on behalf of and/or to others involved in arranging insurance.

The duty requires you to tell an insurer certain matters which will help it decide whether to offer insurance and, if so, on what terms.

The duty applies at the first application for a policy and on any renewal, variation, extension or replacement of the policy.

The type of duty that applies can vary according to the type of policy.

To assist Business Insurance Specialists Pty Ltd (BIS) in protecting your interests, it is important that you tell us every matter that:
- You know, or
- A reasonable person in the circumstances could be expected to know,
- Is relevant to the insurer's decision whether to offer insurance and, if so, on what terms.
BIS will then assist you in determining what needs to be disclosed to the insurer in order to meet your duty.

Examples of matters that should be disclosed are:
- Any claims made in recent years for the particular type of insurance;
- Refusal by an insurer to renew a policy;
- Any unusual feature of the insured risk that may increase the likelihood of a claim.
Failure to comply with the duty may give the insurer the right to cancel the policy or reduce the amount it pays in the event of a claim. If the failure to comply with the duty is fraudulent, the insurer may treat the policy as if it never existed and pay nothing.

Even if BIS is handling claims for you, you must disclose these matters on your proposal. BIS cannot complete or add to your proposal in any way. If you are uncertain about whether or not a particular matter should be disclosed, please contact BIS.

The Duty of Disclosure must be taken seriously as it may affect your right to claim.

The history of losses suffered and claims made by the party seeking insurance, or any person, firm or company closely associated with that party, is one of the principal matters to be disclosed. It is therefore imperative that you maintain an up-to-date record of all such losses and claims.

Whilst BIS will maintain records of all losses reported to us during the term of our appointment as your Broker, we do not accept responsibility for obtaining details of prior losses or for checking in any particular instance that you have made proper and complete disclosure.

We recommend you:
- Supply all management and senior staff with a copy of this Duty of Disclosure Notices within this document;
- Emphasise to them that the Duty of Disclosure applies not only at inception of the insurance, but also when policies are altered or renewed;
- Point out to them that disclosure is most important in matters touching upon past claims, cancellation of insurance covers, premium penalties and any other
Privacy
BIS has always valued the privacy of personal information. If you would like a copy of our Privacy Policy, you can contact us or access it from our website at www.insurancespecialists.com.au/privacy-policy.

Complaints
Contact us and tell us about your complaint. We will do our best to resolve it quickly.

If your complaint is not satisfactorily resolved within 10 working days, please contact Business Insurance Specialists Pty Ltd on (07) 3139 3900 or put your complaint in writing and send it to GPO Box 2217, Brisbane QLD 4001 at the address noted at the beginning of this FSG. We will try and resolve your complaint quickly and fairly.

Business Insurance Specialists Pty Ltd is a member of the Australian Financial Complaints Authority (AFCA). If your complaint cannot be resolved to your satisfaction by us, you have the right to refer the matter to the AFCA. AFCA provides fair and independent financial services complaint resolution that is free to customers.

The AFCA can be contacted at:
Company: Australian Financial Complaints Authority
Postal: GPO Box 3, Melbourne, VIC 3001
Phone: 1800 931 678
Email: info@afca.org.au
Website: www.afca.org.au
I have read the Important Notices.

	Yes	No
Had previous claims? *
Been refused insurance? *
Been charged/ convicted of any offence? *

Boat Insurance Claim Form

Insured Details

Insured Vessel Details

Loss/ Incident Details

Additional Details

Declaration

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Form Summary

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