JETSKI

IMPORTANT NOTICE: It is your duty to disclose all material facts to underwriters. A material fact is one that is likely to influence an underwriter’s judgment and acceptance of your proposal. If your proposal is a renewal, it should also include any change in facts previously advised to underwriters. If you are in any doubt about facts considered materials, disclose them. FAILURE TO DISCLOSE could prejudice your rights to recover in the event of a claim or allow underwriters to void the Policy.

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Thank you for your response. ✨

NAME OF PROPOSER

DATE OF BIRTH (YYYY-MM-DD)

ADDRESS

TELEPHONE NUMBER

MOBILE NUMBER

EMAIL ID

OCCUPATION

PLEASE GIVE DETAILS OF LENGTH AND EXPERIENCE IN USING A JETSKI

LICENSE DATE OF ISSUE

LICENSED ISSUED BY

HAS ANY INSURER DECLINED TO INSURE YOU?(required)

YES NO

IF YES, PLEASE CLARIFY

CLAIMS OR LOSS EXPERIENCE FOR THE LAST 5 YEARS, PLEASE PROVIDE DETAILS

JET SKI MODEL

ENGINE DETAILS

YEAR OF BUILT

SEATING CAPACITY

REGISTRATION NUMBER

IS THE JET SKI FITTED WITH TRACKER DEVICE?(required)

YES NO

IF YES, PLEASE PROVIDE DETAILS OF TRACKER i.e. MAKE, SERIAL NUMBER, YEAR OF BUILT

DATE OF PURCHASE

PURCHASE PRICE

CURRENT MARKET VALUE

VALUE TO BE INSURED

WILL THE JET SKI BE USED FOR PRIVATE PLEASURE PURPOSED ONLY?(required)

YES NO

WHERE WILL YOU USE THE JET SKI?

PLACE AND TYPE OF STORAGE INCLUDING ADDRESS

REQUIRED PERIOD OF INSURANCE (FROM) (YYYY-MM-DD)

REQUIRED EXPIRY DATE (TO) (YYYY-MM-DD)

ADDITIONAL INFORMATION OR OTHER SPECIFIC REQUIREMENTS, PLEASE SPECIFY

We hereby declare that the statements made by us in this online questionnaire are, to the best of our knowledge and belief, complete and true and we hereby agree that this online questionnaire forms the basis and is part of any policy issued in connection with the above proposed risks.