Sailboard Windsurf - Proposal Form

Owner's FULL Name:
Address:
Post Code:
Day Phone:
e-mail address:
Date of Birth (DD/MM/YYYY):
Occupation & Business:
Additional owner full Name:
Home Club
Have you or any other person likely to use the craft, both in respect of the proposed craft or any others:
*Yes / No      
(a) made any claims or suffered any accidents or losses?*
(b) had insurance declined/cancelled or special terms?*
(c) been charged or convicted of any crime/theft/fraud?*
(d) derive any income from boating or sponsorship?*
* If answer is yes to any of the above - provide full details here.
1st board to insure - complete each section for cover to be operative:
Make, Model & Length:
Makers Board Number:
Year Made:
Date Purchased:
Purchase Price:£
2nd board (warranted not afloat at same time as 1st) complete all sections:
Make, Model & Length:
Makers Board Number:
Year Made:
Date Purchased:
Purchase Price:

I warrant all details given are true & complete in every aspect with no information withheld. My craft gear & equipment are in sound, seaworthy condition and will be so maintained whilst insured. I understand and accept the full policy terms, conditions & exclusions detailed on the specimen policy which I have read.

Signed:..................................................

Date cover to start:

[continue]