01424 718800 - Narrowboat/Yacht/Motorboat

01702 710041 - Dinghy/Sailboard/Small Powercraft

On-line Claim Notification Form

for clients of Newton Crum Insurance

Instructions as to what immediate action you must take in the event of theft, accident or damage are set out on the YELLOW form stapled to your policy or renewal receipt.

You may provide initial details either by submitting the following form on-line, by fax 01424 445043, or by phoning claims direct on 01424 718811. Whichever method you choose, do NOT delay.

Fields with * are mandatory, if any are not applicable please enter N/A or 0

Policyholder Details

 

Policy Number:*

 
         

Assured's Full Name:*

 

Exact occupation and nature of business*

         

Email Address:

 

Additional Owners:

         

Home Telephone Number:

 

Mobile Number:

         

Daytime Telephone Number:*

 

Postcode:

         

Home Address:

 
         

Are you registered as a taxable person for VAT?

Yes   No

Was there any other insurance covering craft at time of loss?

Yes   No

Is there any finance/loan or other lien or attachment on the craft?

Yes   No

 

If so, provide details:

Craft

 

Class/Make:*

 
     

Builder:

 
     

Year Built:

 
     

Purchase price:

 
     

Current Value:*

 
     

Name:

 
     

Sail number:*

 
     

Hull number:*

 
     

Name and address of person or firm craft purchased from:*

 
     

Use at time of loss

 

State fully the purpose the craft was being used for:

 
     

If under way, names of passengers/crew:

 
     

If helm different to owner, please state their full name, address and boating experience.

 
     

Who was helming or if accident ashore last person in charge of craft:*

 

Circumstances of Loss/Accident

 

Date it occurred:*

 
     

If exact date not known, please state date last seen undamaged and date of discovery:*

 
     

Is the craft now safe from further damage?

Yes   No

     

If not, what steps are currently being taken to safeguard her?

     

Time of accident:*

 
     

Exactly where:

 
     

Wind force:

 
     

If club or marina please enter name:

 
     

What happened, in detail to cause the loss/damage:*

 
     

Why did that happen:*

 
   

Is anyone else to blame?

 

Yes   No

     

If so, their name:

 
     

Was craft racing or under the preparatory signal at the time of incident?

 

Yes   No

     
If yes,  
     

Was a protest made?

 

Yes   No

     

What was the outcome?

 
     

Their address:

 
     

Their Insurer:

 
     

Why it's their fault:

 
     

Please answer the following section with Yes or No and give details where requested.

     

Were craft/damaged items in good, sound, undamaged condition prior to accident/loss:*

 
     

If accident/loss due to gear/equipment failure, have you taken the issue up with shop you purchased from and if not, why not:*

 
     

Have the hull/foils/spars/sails been previously damaged and/or repaired whether claimed for or not:

 
     

Was there any rot/delamination/saturated wood/osmosis in the hull/decking prior to this claim date:

 

Damage (Hull and/or deck only)

 

Describe where damage is and how large an area etc.

 
 
(Best upload photos of damage and of craft overall both top & bottom, see below)

SPAR-SAIL-FOIL - loss or damage: list all items claimed for & provide full details of each item:


Retain safely all damaged items as inspection may be required.
 

Item

Make/Model

Material

Age

Pre-accident Condition

Is it repairable at all?

 
 

if item still within makers guarantee period or Supply of Goods Act period, please confirm here:

 
 
 

if item still within makers guarantee period or Supply of Goods Act period, please confirm here:

 
 
 

if item still within makers guarantee period or Supply of Goods Act period, please confirm here:

 
 

Other loss or damage: List each item including description, make, pre-loss condition etc:

 
 

Where Can Damage Be Inspected

 
 

Name/Address of repairer you would like to use

 
 

If theft, Police station name

 
 

and address

 
 

Phone

 
 

Reference

 
 
 

If other craft damaged by you and your fault, please state owner's:

Name:

 
 

Address:

 
 

Insurer:

 
 

Photos of the damage usually speeds settlement so if you have facilities to take photos and submit them by jpg or similar with this form or separately by quoting your policy number and name (most important) please do so.

 

Please press the browse buttons below to select the file(s) you wish to submit
(max size 8mb & only JPG images are allowed):

 
 
 
 

Any other information you feel will be helpful to insurers please state below:

 
 

If you have any specific questions please state them below:

 

Important

 

Please read before completing/submitting form.

The fraud bill sets out provisions for general offence of fraud in 3 sections:

  • By false representation

  • By failing to disclose information

  • By abuse of position

Clause 2 makes it an offence to commit fraud by false representation, i.e. the intention of making a gain or causing a loss or risk of a loss to another. The gain or loss does not actually have to take place. Clause 3 makes it an offence to commit fraud by failing to disclose information to insurers in order to gain for him/herself. The bill complements the utmost good faith obligations of the insured/proposer per sections 18(1) and 20(1) of the Marine Insurance Act 1906. Fraud will be prosecuted as well as negating the claim. PLEASE NOTE - Insurers share claim information with each other to prevent fraudulent claims and in the event of a claim may search databases and registers to exchange claim details with participating insurers and services.


I/We declare that the whole of the statements made on this claim form are true in every respect and I/We agree that if any false or untrue statement or any supression or concealment of the material fact has been made, the right to recover under this policy shall be absolutely forfeited. Date and time as per transmission header, policyholder's confirmation of agreement to this declaration by re-confirmation of his/her name below

Please re-confirm your name below and please check that you have answered all questions. We will reply to you with the settlement instructions and advices. Now please press submit.

 
Policyholders name:*
 


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Welcome to Newton Crum - the other people for boat insurance

www.newtoncrum.com/Insurance/Claim