Piranha Insurance Brokers Queensland

Personal Details
Your Name
Address
Contact Phone	Fax
Mobile Phone	Email
Boat Details
Type Of Boat	Make
Age Of Boat (Yrs)	Construction Length
Motor Type	Inboard Outboard Petrol Diesel Horsepower
Motor Manufacturer	Approx Age Yrs
Speed (Excl. Yachts)	Knots or MPH or KPH
Boat Storage
Geographical Limits
Total Sum Insured
Sail Craft Club Racing Risk Required Yes No (Geographical limits restricted as per Policy Wording)
Water Skiers Liability Required Yes No
Third Party Legal Liability Required Yes No
Details Of Losses In The Last 4 Years
Date Of Loss	Amount	Brief Details



Current Insurer
Has the boat been proposed for sale in the last 12 months? Yes No
If so, for how much?

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