SUB AQUA & MARINE INSURANCE SERVICES LTD Please select the required policy WESTFIELD INSURANCE Clasford Lodge, Clasford Farm, Aldershot Road, Guildford, Surrey GU3 3HQ Call from UK 01483 237827 or fax 01483 234856 Call from abroad +44 1483 237827 or fax +44 1483 234856 Terms of business Authorised & Regulated by the Financial Services Authority. Westfield Sub Aqua & Marine Insurance Services Ltd is registered as a limited company in England No. 450587. Registered Office: Clasford Lodge, Clasford Farm, Aldershot Road, Guildford, Surrey GU3 3HQ

BOAT INSURANCE QUOTATION FORM Policyholder Address 1 Address 2 Town County Postcode Email Address Home Tel Type of craft, size, etc. Engine type Outboard Inboard Size of engine (HP) Storage location when not in use i.e. home, marina. Age of craft Age of engine Security in place, i.e. wheel clamp and any engine lock. Values ( sum insured). Value of boat £ Value of engine £ Value of trailer £ Value of boat equipment and electronics £ Do you require water ski liability cover Yes No Name of current insurer How many years' no-claim bonus Target premium £ How did you first hear of our services? (Website, friend, advert, search engine, etc.) We recommend that you print and keep a copy of the form for your own records.