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					  Underwritten by Allianz Australia Insurance Limited
  ABN 15 000 122 850 AFSL 234 708
  2 Market Street Sydney 2000



                                      Club Marine Business Insurance Proposal
  Important Notices. Please read this section before completing this proposal.
   Your Duty of Disclosure: Before you enter into this insurance contract        How to fill out this Proposal: For questions with multiple choice answers,
   with us for the first time, the Insurance Contracts Act 1984 requires you     please select from the box next to the correct answer. For other questions,
   to provide us with the information we need to enable us to decide             please write the information requested in the spaces provided. Make sure
   whether and on what terms your Proposal for insurance is acceptable           you have read the Policy Document we have given to you. If you require
   and to calculate how much premium is required for your insurance.             another copy of the Policy Document or any assistance, please contact your
                                                                                 insurance broker or agent.
   You will be asked various questions when you apply for this Policy.           If there is inadequate space to answer any questions, please use the
   When you answer these questions, you must:                                    additional space at the rear of the Proposal or attach a separate sheet of
   * give us honest and complete answers;                                        paper. Show the page number and question before the information you wish
   * tell us everything you know; and                                            to add, e.g. page 2, Interested Parties' addresses.
   * tell us everything that a reasonable person in the circumstances could
   be expected to tell us.                                                       Definitions:
                                                                                 “we”, “our”, “us” or “Allianz” means Allianz Australia Insurance Limited AFS
   You do not need to tell us about any matter:                                  Licence No. 234708 ABN 15 000 122 850 (except in the declaration).
   * that diminishes our risk;                                                   “you”, “your” means the person proposing for this insurance and any person
   * that is of common knowledge;                                                seeking to be named on the Schedule.
   * that we know or should know as an insurer; or                               “Excess” means either the amount of money specified in the Schedule or
   * that we tell you we do not need to know.                                    otherwise stated in the Policy for each applicable Section that you must
                                                                                 contribute as the first payment for all claims arising out of one event, or the
   Who does the duty apply to? Everyone who is insured under the Policy          period specified in the Schedule or otherwise stated in the Policy for which no
   must comply with the relevant duty.                                           payment will be made by us. There is a special Excess which applies to loss
                                                                                 or damage caused by an earthquake. The Excess is the lesser of $20,000 or
   What happens if you or they do not comply with the relevant duty? If you      an amount equal to 1% of the total Sum Insured for all Property Insured at the
   or they do not comply with the relevant duty, we may cancel the Policy or     Situation under Section 1. The Excess applies to all loss or damage
   reduce the amount we pay if you make a claim. If fraud is involved, we        occurring within the 72-hour period immediately after the earthquake.
   may treat the Policy as if it never existed and pay nothing.
                                                                                 This Proposal uses words that have a special meaning. The definitions of
   Duty on renewals, variations and reinstatements: A different duty             these words can be found in the Policy Document.
   applies for any variation or renewal or reinstatement of the Policy.
   Please refer to your Policy Document for this duty.                           Underinsurance: Section 1 - Material Damage, Section 2 - Business
                                                                                 Interruption, Section 8 - Breakdown, and Section 12 - Boat Dealer Risks of
   Privacy Act 1988: The Privacy Act 1988 requires us to tell you that as an     this Contract contain underinsurance clauses. It is important in these
   insurer we collect your personal and other information in order to:           Sections that you insure the full value of property, Average Income/Gross
   * decide whether to issue a Policy;                                           Profit and declare the total number of machines. If you do not do so, You will
   * determine the terms and conditions of your policy;                          be underinsured and we will not pay your claim in full.
   * compile data; and
   * handle claims.                                                              Claims Made and Notified Sections: The following Section provides insurance
                                                                                 on a ‘claims made and notified’ basis: 1. Section Eleven – Occupational
   We disclose personal information to third parties who we believe are          Liability
   necessary to assist us and them in providing the relevant services and        These sections will only respond to Claims first made against you during the
   products. For example, in handling claims, we may have to disclose            Period of Insurance and notified to us during the Period of Insurance. To the
   your personal and other information to third parties such as other            extent permitted by law, we will not pay for any Claim that you notify us of
   insurers, reinsurers, loss adjusters, external claims data collectors,        after the Period of Insurance has expired.
   investigators and agents or other parties as required by law. We limit        Please note that under sub section 40(3) of the Insurance Contracts Act 1984
   the use and disclosure of any personal information provided by us to          (Cth), where you give notice to us in writing of facts that might give rise to a
   them for the specific purpose for which we supplied it.                       Claim under Section Fourteen as soon as reasonably practicable after you
                                                                                 become aware of those facts but before the Period of Insurance expires, we
   You have the right to seek access to your personal information and to         are not relieved of liability under your Policy in respect of the relevant Claim,
   correct it at any time. Please contact us on 1300 360 529, EST 9am -          when made, by reason only that it was made after the Period of Insurance.
   5pm, Monday-Friday and advise us of any changes. If you do not agree          We do not cover certain prior or pending Claims. Refer to each Section in the
   to the collection of your personal information then, unfortunately, we will   Policy for details.
   be unable to process your Proposal.

   From time to time we may advise or offer you information on other
   Allianz products or services that may be relevant and of interest to you.
   If you do not wish to receive these offers or information please call the
   Allianz Direct Marketing Privacy Service Line – Freecall 1800 000 284,
   EST 9am-5pm, Monday-Friday.




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  General Information
             Quotation, New Business or Renewal (Select)                                                         Quote Number
           Quotation                                                                                                    TBA

                            Intermediary Name                                                   Contact Name                                 Phone Number


                        Contact Name For Insured                                               Phone Number                                    Fax Number


     Is the Insured a existing agent for Club Marine?                                No

     If you are an agent for any other insurer(s), please list insurer(s) name(s)?



     Holding Insurance Company                                                    Premium Paid Last Yr                        Current Policy Expiry Date


     This policy does not cover the following activities
             Marine surveying                                Sale of motor vehicles                                    Tourist activities, including diving
             Marine Engineering/Design                       Sale of motorcycles
             Mining Barges                                   Salvage
             Oil rigs                                        Watercraft for hire / hire & drive / rental/reward / charter / loan/courtesy, etc
             Ship Building                                   Watercraft / vehicles / trailers built to carry hazardous vehicles & related exposures.

     Period of Insurance                                   Effective Date       12/14/2010
                                                            Expiry Date         12/14/2011           at 4:00pm
     Are you registered for GST?                                                   Yes
                                                                                                                                                           ITC %
     The Insured / Company / Sole Traders Names                                                                     ABN                                  applicable
      1.
      2.
      3.
      4.

     Trading Name(s)
      1.
      2.
      3.

     Principal activity

     How many years have you owned/operated a Marine Business?                                                      < 2 years

     Underwriting Criteria
         Have you alone, in partnership, jointly with any other party or, if a corporation, jointly with any of its directors:
      1. suffered any loss(es) (insured or otherwise) totalling more than $5,000 in the last 12 months or totalling more than
         $10,000 in the last 3 years or had 2 or more claims in any one policy year?                                                     Details              No
      2. in the last 5 years had any insurer decline any claim or proposal, cancel or refuse to renew a policy, increase
         premium or impose special terms, conditions or restrictions on a policy?                                                                             No
      3. in the last 5 years been placed in receivership or liquidation or declared bankrupt?                                                                 No
      4. in the last 10 years been convicted of or had any fines or penalties imposed for any crime involving drugs,
         dishonesty, arson, theft, fraud or violence against any person or property?                                                                          No
     If you have answered "Yes" to any of these questions, please attach full details.


     Interested Parties                                                     Address                                                       Nature of their interest



     Number of Employees including labour hire and casuals :
               Principals/Manager                                 Yard/Ship Personnel
                      Sales                                       Workshop Personnel
               Accounts Personnel                                       Other




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     Estimated Gross Turnover of business from:
           Activity                                                   $               Number                              Additional Information
         Sale of Jetski's                       all           $             -                        0
         Sale of Watercraft              1m to 15m            $             -                        0
         Sale of Watercraft             16m to 20m            $             -                        0
         Sale of Watercraft;              over 20m            $             -                        0
         Jetski's on consignment             all              $             -                        0
         Consignment Watercraft         1m to 15m             $             -                        0
         Consignment Watercraft      15m to 20m               $             -                        0
         Consignment Watercraft          over 20m             $             -                        0
         Refuelling Operations                                $             -                        0
         Marina Berthing fees                                 $             -                        0
         Charter & Hire Fees                                  $             -
         Commissions including Finance                        $             -
         Sub Total                                            $             -                        0
         Spare parts for (motors, boats, trailers)                                                   0
         Chandlery Sales                                      $             -                        0
         Servicing/repairing watercraft                                                              0
         Slipping Fees                                        $             -                        0
         Dry docks or racks                                   $             -                        0
         Total value of Sub-contracted Work                   $             -                        0            Example. - MINOR HULL REPAIRS
         Sub Total                                            $             -                        0      Describe Sub-Contracted Work Activities above
         Total Declared Turnover                              $             -                        0

     Are any of the watercraft for sale custom built?                                                                                                  No
         If 'yes', who designs and builds

     Do you perform "mast stepping" rigging activities?                                                                                                No
         If 'yes' is this function carried out by the business or outsourced to a contractor (include contractor's name).



     What percentage of Watercraft are delivered to customers by water?                                                                                      0%

     Describe any other business activity not described above and or any business activity that is not normally considered to be
     connected to a Marine Business



                        Please Note: this policy is not designed to protect non Boat Dealer/Marina activities.


     What major franchises are held or brands that you sell?                                                                                            %
               1
               2
               3

     Do you have a floorplan, finance or similar arrangement to purchase stock of watercraft?                                                          No
         Financiers Name

         Maximum limit - floorplan          $                                   -                        Average usage - floorplan         $                   -

     Which boat shows do you display at? (Include Name of show, Location, Dates, etc)



     Estimated max replacement value of all Boats Displayed at Boat Shows Per Annum                                                                            $0
     The number of boat shows you attend per annum :                                -                                      in Australia,       -    Overseas

           Are electrical cables, power point switches, mains box, regularly checked and maintained?                                                   Yes
              Last date inspected

                                         Please complete "Declared Asset Schedule" tab before proceeding any further.
  Section 1 - Material Damage
     Summary of this Section
         This section covers you for loss or damage to your Buildings, their Contents, employee tools, Watercraft and trailer whilst on land not otherwise
         excluded and it also provides a number of additional benefits. This section will not cover watercraft whilst on water.


                Is this section required?                                                                                                              Yes

     Limit of Indemnity (any one Situation / any one Event)

               Declared Values (Total all situations) if more than one situation, refer split up in the asset schedule.




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         Building(s)                                                                                                                  $           Not Insured
               Piers, wharves, pontoons, dry racks                                                                                    $           Not Insured
             Contents including electronic equipment, employee tools.                                                                 $           Not Insured
         Stock consisting of :
           General merchandise including Parts and Accessories excluding tobacco, cigarettes, fuel in storage tanks, Trailers,
           Watercraft and Customers Goods/Watercraft.                                                                          $                  Not Insured

            Petrol, diesel, LPG, oil or any other fuel held in storage tanks owned by you or for which you are legally responsible.   $           Not Insured
         Stock of Watercraft (incl. trailers) excluding Customers' Goods, consisting of:
         Watercraft for sale excluding Watercraft on consignment.                                                                     $           Not Insured
         Watercraft on consignment for sale.                                                                                          $           Not Insured
         Customers’ Goods excluding Watercraft on consignment for sale.                                                               $           Not Insured
                Specified Items                                                                                                       $           Not Insured
                Specified Items                                                                                                       $           Not Insured
                Specified items                                                                                                       $           Not Insured
                         Total            All situations, as declared by You at each Situation                                        $          Not Insured

                                                  NOTE: Refer to Section Three - Theft and Section Eleven

     Sub limits and Additional benefits (any one Situation / any one Event)
        Pre-completed values are standard policy limits. Higher values may be selected for additional premium.
         Accidental damage                                                                                                       $                      100,000
         Employees’ tools of trade                                                               For each employee per event $                    Not Insured
         Removal of debris                                   The greater of $20,000 or 20% of Declared Value at the Situation or $                       20,000

         Temporary removal of Contents and Stock in trade (other than Watercraft).                                   Max $10,000 $                Not Insured
         Temporary removal for Watercraft.                                                                           Max $50,000 $                Not Insured
         Works of art, antiques and curios ( any one item )                                                                      $               Not Insured
         Extra Cost of Reinstatement                                                                                             $                Not Insured
         Hail Damage to Stock of Watercraft in the Open Air.                                                                     $                Not Insured
         Others                         Parts & accessories in transit                                                           $                Not Insured
         Others                                                                                                                  $                Not Insured
         Others                                                                                                                  $                Not Insured

     Optional Benefit
         Fusion:      (limit as per the policy wording)                                                                                                No
         Flood                                                                                                                                         No
         Diminished Value Allowance                                                                                                                    No


     Excesses
         Loss or Damage to Watercraft                                                                              Per watercraft $                          500
                                                                                                                  Max. per event $                         2,500
         Employees’ Tools                                                                                              Per event $                           500
         Hail damage to Stock of Watercraft in the Open Air                                    $1,000 for each Watercraft and $30,000 in total, for any one Event
         Earthquake                                                                             Lesser of $20,000 or 1% of Total Declared Values at the Situation
         Named Cyclone                                                                                                 Per event $                           500
         All other Events                                                                                              Per event $                           500




  Section 2 - Business Interruption
     Summary of this Section
         This section covers you for the consequential loss that you sustain as a result of an event that would give rise to a claim under Section One and Three
         and a number of additional benefits. This policy will not cover watercraft whilst on water.

     Is this section required?                                                                                                                         Yes
     Limit of Indemnity (any one Situation / any one Event)

     Indemnity Period (Months)                                                                                           (Months)           Nil / Not Required

     Declared Values (Total all Situations)
         Annual Gross Profit
         Payroll (if not included Gross Profit)                        -    Weeks                                                     $           Not Insured
         Loss of rent receivable                                            Weeks                                                     $           Not Insured

         Uninsured Working Expenses
                                                                                                                                      $           Not Insured
                                                                                                                                      $           Not Insured
                                                                                                                                      $           Not Insured
         Total Declared Value                                                                                                         $          Not Insured

     Optional Benefits




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         Additional increase in cost of working                                                                                     $          Not Insured
         Accounts receivable                                                                                                        $          Not Insured
         Claims preparation expenses                                                                                                $          Not Insured
         Suppliers' and/or customers' premises (to 20% of the Total Declared Value)                                                 $          Not Insured


  Section 3 -Crime
     Summary of this Section
                      This section covers you for theft of your property, Loss of Money and breakage of Glass and a number of additional benefits.


         Is Defined Event 1 - Theft Cover required?                                                                                                  Yes

     Limits of Indemnity                                                                                      Limit any one claim
         Contents including Stock consisting of :
         General merchandise including Parts and Accessories
         Petrol, diesel, LPG, oil or any other fuel held in storage tanks owned by you or for which you are
         legally responsible.
         Watercraft including consignment Watercraft and all associated Trailers new and used.



     Sub limits and Additional benefits (any one Situation/any one event)

         Employees' tools of trade         Any one employee $2,000 & any one event $5,000 unless otherwise noted here:              $          Not Insured
         Temporary Removal Contents and Stock excluding Watercraft              20% of applicable limit shown above or              $          Not Insured
         Temporary Removal Watercraft                                           20% of applicable limit shown above or              $          Not Insured
         Other, please describe                                                                                                     $          Not Insured

     Optional benefits
         Parts and accessories attached to Customers &/or your Stock where watercraft is not stolen.                                $          Not Insured

     Excesses
         Loss or damage to Watercraft, including theft of parts from Watercraft.                                  Per Watercraft $                       500
                                                                                                              Maximum per event $                      2,500
         All other events                                                                                             Per event $                        500


        Is Defined Event 2 - Money Cover required?                                                                                                   Yes
     Limits of Indemnity
         Combined                                                                                                                   $          Not Insured
         Outside Business Hours - not in Approved Safe, Strongroom or automatic teller machine.                                     $          Not Insured


     Excesses
         All events                                                                                                                            $           500


        Is Defined Event 3 - Glass Cover required?                                                                                                   Yes

     Limits of Indemnity
         Glass                                                                                                                             Replacement Value
         Illuminated signs                                                                                                                 Replacement Value

     Additional benefits
         Frames, Tiles and Stock , Alarm tapes, signage and temporary shuttering                                                    $                  5,000

     Excesses
         All events                                                                                                                 $                      500


  Section 4 - General Property
     Summary of this Section
         This section covers you against accidental damage to your declared property anywhere in Australia. Cover excludes theft from vehicles not securely
         locked or left ungaraged overnight without being fitted with an active, operational & audible alarm.
         Note there is no cover for stock of watercraft.

     Is this section required?                                                                                                                       Yes

     Limits of Indemnity
         Unspecified Items (excluding electronic equipment)                                     (Max Limit $2,000 any one item)
         Stock                                                                                                                      $          Not Insured
         Specified Electronic Equipment
                                                                                                                                            Limit any one item
                                                                                                                                    $          Not Insured
                                                                                                                                    $          Not Insured
                                                                                                                                    $          Not Insured




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                                                                                                                                     $                Not Insured

         Specified items (excluding electronic equipment) include items valued over $2,000.
                                                                                                                                                   Limit any one item
                                                                                                                                     $                Not Insured
                                                                                                                                     $                Not Insured
                                                                                                                                     $                Not Insured
                                                                                                                                     $                Not Insured

     Excesses
         All events                                                                                                                  $                           500


  Section 5 - Public And Products Liability
     Summary of this Section
         This section covers amounts you are legally liable to pay as compensation for personal injury and/or property damage as a result of an occurrence in
         connection with your Marine Business within the Territorial limits. Note this policy will not cover mechanical or structural repairs, building/rebuilding,
         chandlering, ownership of a marina, ownership or operation of a slip, rigging or painting.


     Is this section required?                                                                                                                             Yes
         NB: Customers' Goods cover in this policy is legal liability cover. For full accidental damage cover refer material damage sections.
     Limit of Indemnity
         General liability                                                                                 Any one occurrence $                          10,000,000
         Products liability                    Limit any one occurrence and in the aggregate during any one period of insurance $                        10,000,000

     Sub Limits
         Resulting damage from faulty workmanship.                                                                                   $                  10,000,000
         Customers' Watercraft/Vehicles in physical or legal control.                                                                $                      500,000
         Customers' Goods in physical or legal control excluding Watercraft &/or Trailers.                                           $                Not Insured
                                                                                                     Declared Turnover               $                            -
     Optional benefits
         Cost of Rectifying Faulty Workmanship              (Cover not available for Ship repairers)                                 $                Not Insured

     Do you import products ?                                                                                                                          No
         If "Yes", please describe items imported and where imported from. Include brochures of items, Include turnover figures. Also include information of
         how products are suitable for purpose if imported to Australia.



         If Yes, please state the % of turnover applicable                        0%              Country                                            Import
     Do you export products ?                                                     0%              Country                                            Export
         If "Yes", please describe items exported and where exported to. Include brochures of items, Include turnover figures. Also include information of how
         products are suitable for purpose for the country exported to.




     Have you assumed obligations under any contract or agreement, eg waivers of liability, hold harmless or
     indemnification agreements? If "Yes" provide full details.                                                                                            No




     Do you provide professional, technical, consultancy, advisory services or the like either for a fee or as an
     ancillary service to your business ?                                                                                                                  No
     If you answered "Yes" to the above question you should consider and discuss with your insurance advisor Section 14 - Occupational
     Liability.

     Describe any business activity performed away from the business location(s).
      1. Within Australia

      2. Overseas

      3. Where application of heat or use of welding is involved.



     Do you have a formal Occupational Health & Safety Program that has been or is being implemented ?                                                     Yes
     Do you hold or conduct Marine Surveys & or issue Seaworthiness Certificates                                                         Details           No

     Do you engage contractors to perform work on your behalf ?                                                                                            No
         If Yes please describe what activities undertaken by contractors




     Excesses
         All claims for faulty work/rectification on Watercraft under 20 metres                                                    $                            1,000
         Property in physical or legal control excluding faulty work/rectification                                  per Watercraft $                              500




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                                                                                                                        per event $                            2,500
         Bodily injury                                                                                                                           Nil
         All other claims excluding bodily injury                                                                                  $                           1,000


  Section 6 - Commercial Motor
     Summary of this Section
         This section covers you for damage to your Vehicles whilst being driven by you or your employees. It provides cover for Vehicles registered in the
         name of the business and used specifically for a purpose within the business. This section will also cover your liability to pay for damage or injury
         caused by your Vehicles (other than injury covered by a CTP policy).


     Is this section required?                                                                                                                           Yes

     The cover
                                         Part "A" – Loss or Damage to Vehicles                                                                          Not Insured
                                         Part "B" – Liability to Third Parties                                                                    $            -
                                         Property Damage and Bodily Injury (CTP Gap Liability) as per policy.

            This section can only provide cover for Vehicles registered in the name of your Marine Business, insure other Vehicles separately.

     Specified vehicles
                            Please provide details of Specified Vehicles in the Specified Vehicles schedule page of this proposal.


     Is there any other information that may be relevant to our decision to insure you or the terms on which we would
     agree to insure you ? (if "Yes" please provide details below)                                                                                        No




     Optional benefit applicable to Part "A"
         Removal of basic excess for windscreen claims                                                                                                    No
         Hire costs following an accident                                                                                                                 No

     Excesses
         Basic                                                                                                                     $                             400
         Additional Excess: All drivers up to the age of 21                                                                        $                             850
         Additional Excess: Drivers aged between 21 and 25                                                                         $                             500
         Inexperienced Drivers Excess , Drivers aged over 25 but have held their licence less than 2 years                         $                             500


  Section 7 - Employee Dishonesty
     Summary of this Section

                   This section covers you for loss of your property resulting from the fraudulent or dishonest act(s) of your employees.

     Is this section required?                                                                                                                           Yes

     Limit of Indemnity - in respect to any one Employee or all Employees                                                          $               Not Insured



     Staff Numbers
         Staff with no access to money, cheques, parts or keys                                                                               Nil / Not Required
         Staff with access to payroll, money, cheques, parts or keys                                                                         Nil / Not Required
         Staff employed to arrange finance or insurance for customers                                                                        Nil / Not Required

     Additional benefits
         Retroactive Period, limit 12 months prior to inception of this section.                                                                        Insured

     Security Questions
         How often are bank statements and books of accounts reconciled?                                                                                Weekly
         How often are stock takes conducted?                                                                                                          6 Monthly
         Do you check references before hiring employees?                                                                                                 Yes
         Method used to pay wages.                                                                                                                      Cheque

     Other Information
         Please describe in full any other information that may be relevant to our decision to insure you or the terms on which we would agree to insure you.




     Excess                                                                                                                                                     $500

  Section 8 - Breakdown
     Summary of this Section




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                    This section covers you against breakdown only of your machinery and electronic equipment with a number of additional benefits.

     Is this section required?                                                                                                                            Yes

     Blanket Machinery
         Blanket Machinery                                                                                       Limit any one loss $                Not Insured
     Specified Machinery.
         List below the description/capacity/size/power.                                                                                   Limit of Indemnity




                                                                                                                                     $               Not Insured

     Specified Electronic Equipment
         List below the description details                                                                                               Replacement Value




                                                                                                                                     $               Not Insured

     Optional benefits
         Deterioration of Stock                                                                                                      $               Not Insured
         Restoration of data                                                                                                         $               Not Insured
         Increased cost of working                                                                                                   $               Not Insured


     Excesses
         Blanket cover                                                                                                any one loss $                         500
         Specified machinery or electronic equipment                                                                  any one loss $                         500
         Deterioration of stock.                                                                                          The greater of 10% of each loss or $500
         Restoration of data.                                                                                              5% of the loss with a minimum of $500
         Increased cost of working                                                                                       per event             2 Days



  Section 9 - Tax Audit
     Summary of this Section
          This section will reimburse you for the costs of retaining professional advisers required to respond to a Tax Audit required by an Australian statutory
                                                              authority but excluding personal taxation affairs.

     Is this section required?                                                                                                                            Yes

     Limit of Indemnity                                                                                                              $               Not Insured

     Underwriting Information
         Is an annual external audit conducted?                                                                                                            No
         Are regular internal audits conducted?                                                                                                            No
         Has an audit by a Commissioner of Taxation been conducted?                                                                                        No
         Has a notification of a forthcoming or likely Tax Audit been received or have you any reason to believe that you are likely to be
         subject to a Tax Audit ?                                                                                                                          No
         Have you had any fines or penalties in the last 5 years following a Tax Audit ?                                                                   No
         Please provide details if you have answered "Yes" to any of the questions above or describe in full any other information that may be
         relevant to our decision to insure you or the terms on which we would agree to insure you.




     Excesses
         Basic excess                                                                                 Greater of 10% of the Professional Fees or $                500



  Section 10 - Inland Transit
     Summary of this Section
         This section covers you for loss or damage to Watercraft and parts whilst in a conveying vehicle, vessel, aircraft or train within Australia only, plus a
         number of additional benefits. Note that limitations apply to the Theft cover see "Product Disclosure Statement".


     Is this section required?                                                                                                                            Yes

     Type of cover required.                                                                       Fire, Collision and Overturning and Theft             Part B
         Part A = Fire, Collision and Overturning. Part B = Fire, Collision and Overturning and Theft. Part C = All Risks not excluded.




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     Limits of Indemnity - Any One Conveyance
           Watercraft                                                                                                                $                  Not Insured
           Parts and Accessories                                                                                                     $                  Not Insured
           Other merchandise and goods. Please describe.
                                                                                                                                     $                  Not Insured

     Optional benefit
           Diminished Value Allowance                                                                                                             Not Insured
           Institute Cargo Clauses                                                                                                                Not Insured

     Underwriting Information
           Estimated annual value of goods being transported
           Watercraft                                                                                                                $                  Not Insured
           Parts and Accessories (Incoming)                                                                                          $                  Not Insured
           Parts and Accessories (Outgoing)                                                                                          $                  Not Insured
           Goods and other merchandise (Incoming)                                                                                    $                  Not Insured
           Goods and other merchandise (Outgoing)                                                                                    $                  Not Insured
           Other merchandise and goods                                                                                               $                  Not Insured
                                                                                                      Total                          $                  Not Insured

     Other Information
           Please describe in full any other information that may be relevant to our decision to insure you or the terms on which we would agree to insure you.




     Excesses
           Watercraft                                                                                               Per Watercraft   $                              500
                                                                                                                        Per event    $                            2,500
           Parts and Accessories                                                                                        Per event    $                              500
           Goods and other merchandise                                                                                  Per event    $                              500
           Other                                                                                                        Per event    $                              500


  Section 11 - Occupational Liability
              This section covers you for claims you are legally liable to pay as compensation due to a breach of your professional duty in the conduct of your
                                    business plus a number of additional benefits. Cover is provided a 'claims made and notified' basis.

     Is this section required?                                                                                                                               Yes

     Important Notice : Claims Made Section
           This section operates on a "Claims Made and Notified" basis. Full details are contained in the Policy document.

     General Questions
      1. Have any claims, either successful or otherwise, ever been made against you or your subsidiaries or related companies or their
         predecessors in business or any present or past director or principal? (If Yes, please attach full details).                                        No
      2.
         Are you, or any of your directors, principals or senior managers, after enquiry, aware of any fact or circumstance which may give rise
         to a claim, against you or your subsidiaries or related companies or your or their predecessors in business or against any current or
         former director or principal whether you consider yourselves liable or not? (if Yes, please attach full details).
                                                                                                                                                             No
      3.
           Has any application for insurance in respect of you or your subsidiaries or related companies or your or their predecessors in
           business ever been declined, cancelled, renewal refused or had special terms imposed? (if "Yes", please attach full details).
                                                                                                                                                             No
      4. Is it the opinion of the Directors that there are reasonable grounds to believe that the business will be able to pay its debts as and
         when they become due and payable?(If No, please attach full details).                                                                               No
      5.
           Are your financial statements and or Income Tax Returns prepared by or checked by an external accountant, tax agent or auditor?
                                                                                                                                                             No
      6. Is it the opinion of your external accountant, tax agent or auditor that your accounts comply with relevant accounting standards and
         represent a "true and fair" view?                                                                                                                   No
      7. Were your financial accounts prepared on the basis of a "going concern" assumption?                                                                 No
      8. If your accounts were audited, were they qualified in any way?                                                                                      No
      9. Are you aware of any significant changes likely to occur to your business operations?                                                               No

     Insuring Clause A - Directors and Officers                                                                                                   Not Insured

     Summary of Insuring Clause A
           This section covers you and your directors and officers for claims they are legally liable to pay as compensation for any wrongful acts committed or
           alleged to have been committed by them in conduct of your Marine Business.

     Limit of Indemnity                                                                                                              $                  Not Insured

           Total Current Assets                  You must attach                                                                     $            Nil / Not Required
           Total Current Liabilities               the financial                                                                     $            Nil / Not Required
           Liquidity Ratio                        statements to                                                          0%          $            Nil / Not Required
                                                  this proposal.




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         Total Assets                                                                                                               $        Nil / Not Required
         Total Liabilities                                                                                                          $        Nil / Not Required
         Shareholders Equity                                                                                             0%         $        Nil / Not Required

         Gross Profit (last 12 months)                                                                                   0%         $        Nil / Not Required
         Net Profit (last 12 months)                                                                                     0%         $        Nil / Not Required

     Date of report from which the financial information above was extracted.

     Other Information
         Please describe in full any other information that may be relevant to our decision to insure you or the terms on which we would agree to insure you.




     Excesses                                                                                                                       $                         1,000



     Insuring Clause B - Errors and Omissions                                                                                                  Insured

     Summary of Insuring Clause B
         This section covers you for claims you are legally liable to pay as compensation due to a breach of your professional duty in the conduct of your
         Marine Business.

     Limit of Indemnity                                                                                                             $              Not Insured

     Underwriting Information
      1. Do you have operations or perform work outside of Australia? (if Yes, please attach full details).                                              No
      2. Do you perform work for clients outside of Australia? (if Yes, please attach full details).                                                     No
      3. Do you have or perform any financing activity other than being an agent for a financial institution in the arranging of finance
         concurrently with or as incidental part of the sale of a Watercraft? (if Yes, please attach full details).                                      No
      4. Have any claims, either successful or otherwise, ever been made against you or your subsidiaries or related companies or their
         predecessors in business or any present or past director or principal? (If Yes, please attach full details).                                    No
      5. Are you, or any of your directors, principals or senior manager, after enquiry, aware of any fact or circumstance which may give rise
         to a claim, against you or your subsidiaries or related companies or your or their predecessors in business or against any current or
         former director or principal whether you consider yourselves liable or not? (if Yes, please attach full details).
                                                                                                                                                         No
      6. Has any application for insurance in respect of you or your subsidiaries or related companies or your or their predecessors in
         business ever been declined, cancelled, renewal refused or had special terms imposed? (if Yes, please attach full details).
                                                                                                                                                         No
      7. Do you provide tuition / classes on how to handle Watercraft for a fee?                                                                         No
      8. Do any insured persons hold outside directorships at the request, or with the consent, of the corporation or its subsidiaries for which
         cover is required? If 'yes' is selected, please provide details below:                                                                           No
                Name of Director               Name of outside entity         Reasons for holding directorship            Details of current D&O insurance
                                                                                                                                 for outside company
                                                                                                                        (Insurer, Limit of Indemnity, Excess)




         For each organisation declared above, please provide details of any shareholder with more than 15% shareholding.


     Excesses
         Claims under Additional Benefit Trade Practices Act, Fair Trading Act/s                                                    $                         1,000
         Claims under Additional Benefit Libel and Slander                                                                          $                         1,000
         Claims under Additional Benefit arising from activities as a Finance or Insurance Agent                                    $                         1,000
         All other Claims                                                                                                           $                         1,000

     Insuring Clause C - Employment Practices                                                                                                Not Insured

     Summary of Insuring Clause C
         This section covers you and your employees for claims they are legally liable to pay as compensation for any claim for certain employment practices
         and costs and expenses you incur defending the claim.

     Limit of Indemnity                                                                                                             $              Not Insured

     Underwriting Information
         Do you have a written policy on sexual harassment and anti discrimination ?                                                                     No
         Do you have documented procedures for the termination of employees ?                                                                            No
         Do you seek external legal advice on employment issues ?                                                                                        No
         Do you have an employee manual? (Please attach to proposal if more than 100 employees)                                                          No
         Number of employees -
                             As at      Apr 2010                                                                                                                   0
                             As at      Apr 2011                                                                                                                   0
                             As at      Apr 2012                                                                                                                   0




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                          Average over last 3 years

           Number of employees ceased employment last year                                                                                                         0
           Number of employer-initiated staff terminations in the last 3 years                                                                                     0
           Number of employees currently earning in excess of $80,000 p.a.                                                                                         0
           Number of employment Practices cases brought against you in the last 3 years                                                                            0

     Optional Benefit
           Insolvent Trading                                                                                                                  Not Insured
           Note: If cover is required, financial statements must be provided.
     Excesses                                                                                                                       $                       1,000

  Section 12 - Boat Dealer Risks
     Summary of this Section
            This covers you for loss or damage to your boats and boats that you display and demonstrate for the purpose of sale. It also covers you for your legal
            liability to pay compensation to third parties for damage or injury caused by your boat(s) that you are displaying or demonstrating.    This will not
                                  cover watercraft used for hire, charter, hire & drive, rental ,courtesy, loan or reward or "in survey".

     Is this section required?                                                                                                                          Yes

     PART A - Loss or Damage to the Insured Boat

     Total value of all watercraft for sale                      (Carried forward from General Information section) $                                              -
     Total value of all watercraft on dislplay at Boat Shows annually                                                                                             $0
     Limit any one Watercraft excluding on consignment                                                       Up To                                                $0
     Limit any one Watercraft on consignment                                                                 Up To                                                $0
             Number of Insured Boats on water at any one time ?                       0                  Limit any one Boat                                       $0
                                                                                                        Total Value All Boats                                     $0

           Number of Personal Watercraft on water at any one time ?                   0           Limit any one P/ Watercraft                                     $0
                                                                                                  Total Value All P/Watercraft                                    $0

       Additional benefits Part A ( as per the policy wording )
           Trailer
           Slipping incidental to repair
           Reasonable Salvage Charges

     PART B - Legal Liability to Third Parties
     Limit of indemnity                                                                         Boats                               $               Not Insured
                                                                                                Personal Watercraft                                   Not Insured
     Optional Benefit Part B
           Water Skiing                                                                                                                             Not Insured
     Optional Benefits applicable to Part A and Part B
           Personal Use of Boats &/or Personal watercraft                                                                                           Not Insured
           Social Yacht Racing                                                                                                                      Not Insured
           Yacht Racing                                                                                                                             Not Insured
           Time Trails                                                                                                                              Not Insured

     Specified Watercraft
           Year                         Make                                 Model              Value             Use
      1.                                                                                                      -
      2.                                                                                                      -
      3.                                                                                                      -

     Watercraft Displayed at Boat Shows
     Number of Boat Shows Per Year                                       -                      Total Value                                    $0
     Boat shows noted as regularly attended by insured
           As per details provided in the General Information section.
     Excesses
        Personal Watercraft                                                                                                         $                       1,000
           Boats other than Personal Watercraft                                                                                     $                         500
           Maximum any one loss                                                                                                                             $2,500
           Theft of accessories/Malicious damage                                                                                    $                         500


  Section 13 - Marina Liability
     Summary of this Section
           This covers you for amounts you are legally liable to pay as compensation for certain personal injury and/or property damage which occurs in
           connection with your Marina Business. This section also has optional benefits for slipway operation and repairers liability. You may purchase these
           optional benefits for an additional premium.

     Is this section required?                                                                                                                          Yes

     Number of berths less than :                                  5m                10m                15m             20m             25m          Over 25m




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                            Fixed                                                      0
                            Swing moorings

                            Rack & stack

                            Dinghy racks

                            Buoys

                            Average value per boat         $              -   $              -     $             -       $        -     $        -      $         -
                        Total insured value of boats held as at date of application                                                     $               Not Insured

                        Number or percentage of berths for private customers                                                                                           0
                        Number or percentage of berths for business                                                                                                    0

     Limit of Liability                                                                                              any one occurrence $               Not Insured


     Is the marina affiliated with a resort, club, etc?                                                                                                      No

     Are there plans for structural alterations to the marina in the next 5 years?                                                                           No

     Are demolition works contemplated or being planned for the next 5 years?                                                                                No
         If 'yes', have plans or concepts been submitted to council?                                                                                         No

     Does a Dock master or caretaker live on premises?                                                                                                       No

     Security
         Please provide details of security in the Asset Schedule page of this proposal.

     Facilities                                                                                                                                Declared Values
         Shower                                                                                                                         $              Not Insured
         Storage specifically for dingys                                                                                                $              Not Insured
         Toilets                                                                                                                        $              Not Insured
         Club house                                                                                                                     $              Not Insured
     Other Tenancies, please list :




     Parking facilities owned or operated :                                       Number of parking spaces                                                   0
                                                                                  Is a fee charged for parking                                               No

     Does insured engage contractors to perform work at the Marina ?                                                                                         No

     Is the business involved in fuelling operations?                                                                                                        No

         Self fuel or Attendant?                      Attendant

         Location of fuel                     In ground        In water        Above ground         Above water
         tanks/capacity :          (litres)      TBA

         No. of pumps                            0                                                      Are we covering owners liability for tanks?          No

         Do you own the tanks used to store fuel?                 No
                       If 'no': a) Who owns the tanks?:                                                                      b)Are the tanks insured?        No

         If there are any plans to remove/close/upgrade tanks in next 3 years please provide details.



         If any of the storage tanks have ever had a leak/spill or release in the past please provide details.



         If you have had action taken by any authority as a result of environmental damage caused by or through the tanks please provide details.



         If you have been fined by any agency or authority for breaches of an environmental nature please provide details.



         Are all tanks in compliance with current EPA regulations?                                                                                           No

         When were tanks installed, if more than one tank advise individual dates.


         Have tanks been lined?                                                                                                                              No

         Tank leak protection used:
               Auto Tank guage




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                 Dipstick monitoring
                        Visual
                       Other, describe

         Date piping installed                                                                                    Piping construction
         Length of piping from tanks to fuelling area:                                            metres
         When was piping last checked for leaks?
         Dispenser method

         Types of fuel offered:
         Describe safeguards in place against spillage or leaks:



     Optional Benefits
         Slipway Operation                                                                                                                                   No
         Repairer's Liability                                                                                                                                No
         Rectification of Faulty Workmanship Consequent Upon Damage                                                                                          No
                         Rectification of Faulty Workmanship                                                                            $               Not Insured
         Boat Builders Liability                                                                                                                             No

     Excesses
         Basic                                                                                                                          $                          1,000
         Losses arising out of storage of fuel or fuelling operations                                                                   $                          2,500
         Slipway Operation                                                                                                              $                          2,500
         Repairer's Liability                                                                                                           $                          2,500
         Rectification of Faulty Workmanship Consequent Upon Damage                                                                     $                          2,500


  Section 14 - Watercraft Repairer's Liability
     Summary of this Section
         This covers you for amounts you are legally liable to pay as compensation for damages resulting from loss or damage to watercraft, conents or
         machinery and equipment of watercraft in your possession, removal of wreck, loss or damage to third party property which occurs in connection with
         your Watercraft Repair Business. This section also has optional benefits for detention of any watercraft, death or personal injury of third parties,
         rectification of faulty work and when you or your employees work on board a watercraft at sea. You may purchase these optional benefits for an
         additional premium.

     Is this section required?                                                                                                                               Yes

     Limit of Indemnity required:         $0

     Number of years in the watercraft repair business?                                5          Years

     Number of employees:                 Full Time                 0              Part Time               0
     Please advise your annual watercraft repairing revenue for this year, and the estimated revenue for next year.
     Income - Repair:        This year    $0                                                               Estimated next year          $0


     Please provide full details of your repair facilities i.e. graving docks, floating dry docks, syncrolifts, repair sheds etc. Please provide plans, brochures etc.




     Please detail the type of repairs that you perform, split as a percentage of watercraft repair revenue:

         Hull (non Hot Work)                             0%                   Engine                            0%
         Burning /Welding /Hot Work                      0%                   Electrical                        0%
         Painting                                        0%                   Boiler                            0%

     Please advise the types of watercraft on which you work, split as a percentage of revenue:

         Passenger Vessels                               0%                   Other                             0%
         Yachts                                          0%                   Please provide details below
         Motor Cruisers                                  0%


     Do you perform watercraft conversion /reconstruction work?                                                                                               No

     If “Yes”, what percentage of annual ship repairing revenues does this represent:                                                             0%
     Do you perform any work on watercraft that is not repair, reconstruction or conversion work?                                                             No

     If “Yes”, please describe the nature of such work and advise what percentage of annual watercraft repairing revenues this                    0%
     represents.
     Details:-




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     Please advise how much work you sub-contract out, as a percentage of revenue.                                                        0%


     What type of work do you sub-contract out?



     Do you have a sub-contractor vetting programme or Approved Contractor Scheme?                                                                  No

     What percentage of your annual watercraft repairing revenues are from work sub-contracted in?                                        0%

     Within how many kilometers from the yard are the following operations performed?
     (a) watercraft movements in connection with repair operations:                                          0 Klms
     (b) Watercraft test /trials:                                                                            0 Klms

     Please advise the extent of any contractual liability arising from vessel movements, test or trials.



     Are gas-freeing operations performed at your yard(s)?                                                                                          No
     If “Yes”, is gas-freeing certification issued by your own employees or by outsiders?


     If your own employees perform gas-freeing work, please provide details of their names, experience and professional qualifications:



     If outsiders perform gas-freeing work, do you have any contractual liabilities relating to this?



     How close is the nearest Public Fire Department Station?                                                0 Klms
     Please provide full details of your own private fire fighting resources:



     What is the maximum number of vessels in your yard at any one time?

     Please provide details of any repairs carried out away from the yard.



     What percentage of annual ship repairing revenues does this represent?                                0%

     Please provide details separately of any work performed other than watercraft repair, such as fabrication, general engineering,
     assembly etc, including annual revenue.



     Is yard fenced?                                                                                                                                No

     Please describe security measures, including watchmen.



     Please provide details separately of:
     a) Hot Work Safety Procedures



     b) Yard Safety Management Programme



     Please provide copies of:
     a) your standard contract terms, including applicable limitations of liability.
     b) any contract that extends your contractual liability beyond the terms of your standard contract.
     Please provide details of any hold harmless or indemnity that you have given to another party under any agreement.



     Optional Benefits
         Detention                                                                                                                                  No
         Personal Injury                                                                                                                            No
         Rectification of Faulty Workmanship Consequent Upon Damage                                                                                 No
         Rectification of Faulty Workmanship                                                                             Limit $               Not Insured
         Travelling Workmen                                                                                                                         No
     Excesses
         Basic                                                                                                                                        $2,500

  Declaration
     This declaration applies to all the insurances being applying for.




4/24/2012 10:20 PM                                         27f603af-a507-4c03-bccd-d8ab59d1eb8c.xls                                                          Page 14
     I/We declare and agree:

      1. that I/we have received or have been offered a copy of the Marine Business Insurance Policy Document;
      2. that I/we have read the information concerning the Duty of Disclosure and other Important Notices;
      3. that I/we have been truthful and accurate in completing this form and declaration and have not withheld any information likely to affect the acceptance
         of this insurance;
      4. that I/we have either completed this form personally or, if it has been completed by somebody else, I/we have checked that the questions have been
         fully and accurately answered;
      5.   to make the Premises available for inspection by us if so requested;
      6.   that upon acceptance, this insurance shall be subject to the Marine Business Insurance Policy;
      7.   that where personal information has been provided on someone else's behalf, that person consented to this provision;
      8.   that I/we have read and understood the Privacy Act 1988 information and consent to the collection, storage, use and disclosure of personal and
           sensitive information of all persons covered in this document.
       9. that if anything happens during the Period of Insurance that alters any of the information provided, I/we will promptly inform the insurer.
      10. that I/we realise that if I/we have not complied with the Duty of Disclosure and Duty of Good Faith any claims may not be met.
      11.
          that we will only agree to offer insurance as described herein. If your quotation request or broker's invoice contains terms and conditions that differ
          from those described herein, these will not be binding on us and will not form the basis of the contract between you, the insured and us.
      12. that completion and submission of this proposal in electronic form by your agent or broker is acknowledged as being "signed".

           Signature                      Name                                                   Position                            Date



   Lodgement
                       When completed, please email the completed declaration to "marinebusiness@allianz.com.au"




4/24/2012 10:20 PM                                        27f603af-a507-4c03-bccd-d8ab59d1eb8c.xls                                                                  Page 15
Club Marine Business Insurance
Proposal
                                  ASSET SCHEDULE: Description of Properties Insured


Sit
       Street Address   Suburb   Postcode   State   Occupation at each situation   Age of Bldg   Bldg Construction   Construction - Floors
No.




  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
 19
 20
 21
 22
 23
 24
 25
 26
 27
 28
 29
 30
                                                                           ASSET SCHEDULE: Security and Fire Protection

                                                                                                                                        Fences
                                                                                                                                                                       External After hours
                                                                             Annually        Alarm Type (must                           around       Removable
   Construction - Fixed     Construction - Floating                 Fire                                             Protection for                                    security    security
                                                      Sprinklers           serviced fire   protect entire premises                     perimeter Bollards or barriers
     Marina Berths             Marina Berths                       hoses                                               Windows                                          lighting  guards or
                                                                           extinguishers    or show "No alarm")                       and gates on    (all Exits)
                                                                                                                                                                      after hours  patrols
                                                                                                                                        all exits

update selections         update selections
                                                        ASSET SCHEDULE: Declared Values

                                                                                       Stock of petrol, diesel,    Stock of          Stock of         Customers’
                                    Contents       General merchandise including
                    Piers,                                                              LPG, oil or any other Watercraft for sale   Watercraft           Goods         Total
    Buildings                       including     Parts and Accessories excluding
                   wharves,                                                              fuel held in storage   (incl. trailers)  (incl. trailers)     excluding     Section 1:
    (Including                      electronic   tobacco, cigarettes, fuel in storage
                 pontoons, dry                                                         tanks owned by you or      excluding              on          Watercraft on    Material
     signage)                      equipment,      tanks, Trailers, Watercraft and    for which you are legally Watercraft on
                     racks                                                                                                        consignment        consignment     Damage
                                 employee tools.   Customers Goods/Watercraft.               responsible.       consignment.         for sale.          for sale.
$                $               $                 $                                    $                        $                  $                $               $
$                $                                 $                                     $                                          $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
$                $               $                 $                                     $                       $                  $                $               $
B = Brick/Massive
0 = Combustible
E = EPS ( Panel Foam )
R = Fire Resisting
M = Mixed
N = Non-combustible



0 - Not Sprinklered
1 - Sprinklered


Yes
No
Proposal
Specified Vehicle Cover : information for Section 8 - Commercial Motor

Vehicle Details
                                                                                                                                                                   Estimated   Check to
                                                                                                                                          No Claim                             ensure that
                                                                                                                                                                     Market
                                                                                                   If there is a regular                  Bonus =                              all data is
                Year of                                        Engine size    Rego                                                                     Garaging   Value/ Sum
Vehicle No.                     Make      Model        Body                           VIN Number    driver, what is the    Date of Birth Number of                             entered if a
              Manufacture                                      (Cylinders)   Number                                                                    Postcode     Insured/
                                                                                                       driver's name.                    years claim                           Driver's
                                                                                                                                                                     Agreed
                                                                                                                                            free                               Name is
                                                                                                                                                                      Value
         1                                                                                                                                                                     present.
                                                                                                                                                                               No Record
         2                                                                                                                                                                     No Record
         3                                                                                                                                                                     No Record
         4                                                                                                                                                                     No Record
         5                                                                                                                                                                     No Record
         6                                                                                                                                                                     No Record
         7                                                                                                                                                                     No Record
         8                                                                                                                                                                     No Record
         9                                                                                                                                                                     No Record
        10                                                                                                                                                                     No Record

Vehicle details - Accessories. This policy will cover all standard accessories on the vehicles valued under $1,500.
Please list any non-standard accessories or modifications(e.g non factory: turbo, suspension, paint, body kits) to the Specified Vehicles above.
Vehicle No.    Accessories Detail
          1
          2
          3
          4
          5
          6
          7
          8
          9
         10
                                       Additional Information
         Describe all activities associated with the issuance of Marine Surveying below and details of qualifications:
 1
 2
 3
 4
 5
 6
 7
 8
 9
10


     Describe all activities associated with the issuance of Seaworthiness Certificates below and details of qualifications:
 1
 2
 3
 4
 5
 6
 7
 8
 9
10
                              Claims Information
     Details - Over $5,000                         D.O.L   Status   Paid   O/S
1                                                                   $0     $0
2                                                                   $0     $0
3                                                                   $0     $0
 4                                                                  $0     $0
 5                                                                  $0     $0
 6
 7
 8
 9
10

     Details - Under $5,000                        D.O.L   Status   Paid   O/S
 1
 2
 3
 4
 5
 6
 7
 8
 9
10

				
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