Personal Details
Assured's Name*:    
Address*:
Postcode*:
Telephone*: Email:
Age*:  years Experience*:  years


Vessel's Details
Vessel Name: Craft Flag*:
Make/Model*: Year of Make*:
Hull Material*: Length*:  
Date of last out of water survey (if you have one):


Engine's Details
Make of Engine: Year of Make:
Power:   Max Design Speed*:  knots
Engine Type:  Inboard
 Outboard
 Petrol
 Diesel
 Single
 Twin


Vessel's Use
Use*: If Charter, max number of passengers:
Cruising Range*:
Mooring Location*: Mooring Type*:
  If your cruising range or mooring type isn't included in the options above then please then please select 'Other' and make a note in the additional information section
In Commission:  
From*: To*:


Cover Details
Total Sum Insured*:   No Claims Discount*:
Insurance Start Date*:
Current Insurers:    
Have you had any claims in the last 5 years*?  Yes    No
  If yes, please provide details in the box below including the date & value of each claim.
 
Is Water Skiers Liability Required?  Yes    No
Is Towing of Toys Liability Required?  Yes    No
  Any additional information, or if your preference isn't included in the above sections then please make a note here:
 
Where did you hear about Velos*:
If you have a reference number, please quote it here:
 

 Once you are happy your details are correct, click 'Submit Enquiry' to
 submit your enquiry to Velos Insurance Services.

 We will endeavour to respond to your enquiry within one working day.

 * these fields are compulsory.