Proposal Name:

Business Registration Number:

NRIC/FIN Number:

Date of Birth (YYYY-MM-DD):

Year(s) of Experience in Handling Pleasure Craft:

Occupation:

Occupation Nature: IndoorOutdoor
Valid Singapore Pleasure Craft License?
YesNo
Nature of Business / Business Industry:

Boat Name:

Boat Registration No.:

Date Of Purchase (YYYY-MM-DD):

Purchase Price (S):

Year of Manufacture:

Maximum Designed Speed:

Material of Hull & Dimension:

Gross Tonnage:

Model/Year:

Type of Engine/Serial No.:

Inboard/Outboard:

Maximum Passengers Capacity:

Area of Cruising:

Where will the boat be moored when not in use?

Current Insurer:

Sum Insured (Comprehensive Coverage):

Outboard Motor Value:

Third Party Liability Limited (Including Passenger Liability):

To include Legal Liability to and of Water Skier & the Limit of Liability required?
YesNo
Coverage Period-From (YYYY-MM-DD):

Coverage Period-To (YYYY-MM-DD):

Any Claim(s) for the past 3 years?
YesNo
If yes, please enter accident(s)/claim(s) details:

Existing Renewal Notice (Optional):

Company's ACRA/Business Profile (Optional):

Contact Personnel:

Contact Number:

Email:

Prefer to contact via:
Phone CallSMSE-Mail

By submitting this request, I understand that all information provided above are correct and PERLE is given the permission to use my information. I acknowledge having read through the Privacy Policy and consent to use my information for the purpose of obtaining insurance quotes and to be contacted for quotation updates. Where the data provided is not mine, I confirm that I have the consent of the owner to provide such data.

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