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* Tom Leonard Marine *
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Insurance

Allianz Pleasure Craft Insurance offers you complete peace of mind to enjoy your boat. The benefits include:
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* * Protection for your craft if damaged by storm, accident, fire, theft, attempted theft or vandalism
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* * Protection for your passengers
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* * Easy Payments- 12 monthly instalments, credit card or cheque
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* * Fast claims handling
Allianz
Plus as an Authorised Repair Centre you'll have the peace of mind of knowing your boat is being professionally repaired. We will send you a copy of the Allianz form so you know the information fields required.
* * PERSONAL *
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*Name *
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*Address *
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*Postcode *
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Occupation *
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Tel No (Work) *
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*Tel No (Home) *
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*Email *
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* denotes a mandatory field 
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* * VESSEL *
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*Vessel Name *
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*Class or type *
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*Year of build *
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*Date last surveyed *
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*Date purchased *
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*Price paid £ *
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*Material of Hull *
Wood Steel GRP Other
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If other
please specify		 *
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Dimensions *
* length overall length overall *
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* extreme breadth extreme breadth *
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* draft in working trim draft in working trim *
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* denotes a mandatory field 
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* * ENGINE *
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*Twin/Single Screw *
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*HP of each engine *
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*Maker *
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*Year of Build *
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*Max designed speed *
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What fuels used: *
* main engines main engines *
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auxiliary machines auxiliary machines *
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Serial Number of outboard motors *
1. *
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2. *
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3. *
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* denotes a mandatory field 
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* * FIRE PRECAUTIONS *
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*What fire extinguishers are kept on board? *
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*Is any petrol used or stored below deck? * Yes  No    
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*Is the vessel fitted with bottle gas equipment? * Yes  No    
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If so, is all delivery tubing made of copper? * Yes  No    
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If no, please give details *
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* denotes a mandatory field 
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* * INSURANCE RECORD *
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Have you had experience of handling:
*  - craft of this description in the area you are planning to sail? * Yes  No    
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*  - other craft in this or other areas * Yes  No    
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*have you had any accidents or losses during the past 5 years? * Yes  No    
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*Has any insurer declined your proposal, refused renewal of your policy, loaded the premium or imposed special conditions? * Yes  No    
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If yes, please give details: *
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* denotes a mandatory field 
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* * USE *
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*Will the vessel be used for purposes other than private pleasure? * Yes  No    
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If yes, please give details: *
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*Will you allow others to use the vessel in your absence? * Yes  No    
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If yes, please give details: *
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*Will the vessel be used to tow Waterskiiers or persons on toys
(such as Bananas, Biscuits, Rings)?~		 * Yes  No    
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~ If the answer to this question is "YES" we will be unable to provide the liability cover required.
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Cruising Range required:
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*1) UK & Irish non-tidal waters * Yes  No    
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*2) UK & Irish inland & Coastal waters * Yes  No    
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*3) Including Brest to Elbe * Yes  No    
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*Where is the vessel normally moored when in commision? *
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When will the vessel be laid up?
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*From: * day   *month 
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*To: * day   *month 
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*Where will the vessel be laid up? Ashore  Mud berth  Afloat
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*Do you require cover for racing risks
(ie damage to masts, spars, sails, standing and running rigging while racing)		 * Yes  No    
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If yes please state the full replacement cost of these items * Total £ 
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* denotes a mandatory field 
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* * COVER REQUIRED *
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*Effective from: *
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*Sums to be insured: *
*Hull Machinery, equipment etc. * £ 
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*~Dinghy and/or boats * £ 
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*Outboard motor * £  £  £ 
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*Trailer * £ 
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*Other * £ 
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~Dinghies & boats must be permanently marked with the name of the insured vessel
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Special Equipment
(please specify with value)		 *
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*Total Sum Insured £ *
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*Do you wish to carry an excess * Yes  No    
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If yes, please state the sum £ *
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Please state the limit of idemnity any one accident required in respect of claims by
*Third Party and Passengers * £1,000,000    £2,000,000    Other
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* denotes a mandatory field 
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* Tom Leonard Boat Sales & Maintenance
Crawfords Marina, Carrybridge, Lisbellaw, Co. Fermanagh		 *
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* * 028 6638 7806 *
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