Club Marine | Claim Notifications

1300 00 CLUB (2582)

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* I have read and I make the declaration in the declaration and privacy notice

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Member/Client number

*Policy number

*Insured name

*Address

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*Post code

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*Phone (incl. area code e.g. 0733334444)

*Is the policy/vessel registered for GST purposes?

Yes

*ABN

*Input Tax Credit (ITC)

* Have you or any other co-owner of the boat had any claim refused, insurance declined or special conditions imposed on any insurance policy in the last 5 years?

Yes

* Have you or any other co-owner of the boat been convicted of any criminal act in relation to drugs, dishonesty, arson, theft, fraud, burglary, violence against any person or property, malicious or wilful damage in the last 5 years?

Yes

* Have you or any other co-owner of the boat been declared bankrupt & not discharged within the last 12 months?

Yes

* Have you or any other co-owner of the boat been convicted or had any fines or penalties imposed for any alcohol or drug related driving or boating offences or had their licence cancelled, disqualified or suspended due to offences in the last 3 years?

Yes

* Have you or any other co-owner of the boat made a claim against your own insurance policy in the last 5 years?

Yes

* Has the boat been used for any Commercial, work or commuting purposes (including charter)?

Yes

* Has any part of the Boat, Motor and/or Trailer been modified or enhanced outside the original manufacturers specifications?

Yes

* Is the boat used in a syndicate, time share or equity arrangement, including for Hire, Reward, Air BnB or similar "Uber" type arrangement?

Yes

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Club Marine Limited ABN 12 007 588 347 AFS Licence No. 236916 issues this insurance as agent of the insurer Allianz Australia Insurance Limited ABN 15 000 122 850 AFS Licence No. 234708