Quote Request Form

Quote Request Form
Webform For
Reply to Email
maidstone@havenkjspecialist.com
Sub Date

DayMonthYear
What date would you like your cover to start? (If you are unsure of the date, please use todays date)*

DayMonthYear
Title*
Title (other)*
First Name*
Surname*
Date of Birth*

DayMonthYear
Occupation*
Address*

House Name/No. and Street

Street Address Line 2

Town/CityCounty

Post Code
Email Address*

Confirmation Email
Phone Number*
How did you hear about us?*
Name of Referrer*
How did you hear about us (other)*
Data Processing Consent*

YesNo
In order for Haven Knox-Johnston to provide you with a quote, Data Processing Consent must be set to Yes. If you would prefer to speak to one of our specialists please call 01843 603345.
Marketing Consent*

YesNo
How would you like to receive marketing information?*
By providing this information you consent to Haven Knox-Johnston contacting you by any of the methods that you have provided details for, and that we will process such information in accordance with our privacy notice https://www.howdengroup.com/uk-en/privacy-data-protection-policy

How many years experience with this type of craft?*
Do you have any boating qualifications?*

YesNo
Boating Qualifications*
Do you have a no claims bonus?*
Any claims or convictions within the last 5 years?*
Number of claims in the last 5 years?*
Please provide details of claim or conviction, including date of claim, details of incident and how much was paid if applicable.*
What type of vessel are you insuring?*
Boat Name*
Make and Model*
Length (Feet) OLD
Length (Feet)*
Year of Build*
Type of Main Engine*
Engine Make*
Engine Horsepower.*
Engine Horsepower OLD*
Construction of Hull*
Construction (Other)*
Top Speed in Knots*
Top Speed in Knots OLD*
Year of Purchase*
Price Paid (£) OLD*
Price Paid (£)*

Please enter the sum insured where applicable*

Country of Registry / Flag Authority*
Cruising Range*
Cruising Range (Other)*
Use of Vessel*
Type of Mooring*
Type of Mooring (Other)*
Type of Mooring (Ashore)*
Ashore Mooring (Other) *
Location of Mooring*
Optional Cover
Do you require racing risks?*

YesNo
Value of MSSR (£) OLD
Total value of Mast, Spars, Sails and Rigging
Value of MSSR (£)*
Total value of Mast, Spars, Sails and Rigging
Water Skiers Liability Required*
Towing of Toys Liability Required*
Latest Survey & Valuation
Please attach a copy of your latest survey and valuation if applicable.

Cancelof
Should be Empty:

Optional Cover