Owner |
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Name: |
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Street Address: |
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City/State/ZIP: |
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Country: |
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Home Phone: |
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Work Phone: |
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Cell (mobile) Phone: |
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Email address: |
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Boat |
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Name: |
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Boat Type: Power Sail |
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Hull Type: Monohull Catamaran Trimaran |
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Year: |
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Make: |
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Model: |
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Bridge clearance: |
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Boat Length: |
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Beam: |
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Draft: |
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Boat Documentation or State Reg. Number: |
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Current paperwork aboard: |
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VAT or Tax Certificate aboard:
(Intl deliveries only) |
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Engine |
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Manufacturer: |
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Type: |
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Number: |
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Fuel Type: Diesel Petrol |
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Horsepower: |
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Fuel Capacity (gals): |
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Fuel Consumption: GPH |
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Cruising Speed (KnPH): |
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Range (nautical miles): |
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Manufacture year: |
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Last service date: |
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Generator Yes No |
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Manufacturer: |
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Fuel Type: |
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Size: |
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Manufacture year: |
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Last service date: |
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Electronics / Navigation |
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VHF: |
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SSB or HAM: |
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Depth/SONAR: |
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RADAR: |
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GPS: |
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AIS: |
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Auto Pilot: |
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Wind Vane Steering: |
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Systems |
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Inverter: No Yes, 110V Yes, 230V |
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Bow Thruster: No Yes |
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General |
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Water Capacity (gals): |
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Water maker: Yes No |
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Heating in Main Salon and Staterooms: Yes No |
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Air Conditioning in Main Salon and Staterooms: Yes No |
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Cooking/eating utensils on board: Yes No |
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Propane appliances on board: Yes No |
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Cooking fuel full: Yes No |
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Black water storage: Holding Tank Lectrasan None |
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Holding tanks pumped out: No Yes N/A |
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Accomodation |
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Staterooms: 1 2 3 4 |
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Heads: 1 2 3 |
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Shower: Yes No |
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Linens and bedding on board: Yes No |
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Safety |
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Adult Life Jackets (number): 0 1 2 3 4 5+ |
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EPIRB: Yes No |
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If Yes, registered: Yes No |
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If Yes, date last inspected: January February March April May June July August September October November December 2015 2014 2013 2012 2011 2010 earlier |
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First Aid kit: Yes No |
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Fire extinguishers (number): 0 1 2 3 4 5+ |
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In date Flares/distress signals: Yes No |
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Abandon Ship bag: Yes No |
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Horn: Yes No |
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Emergency steering: Yes No |
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Manual Bilge pump: Yes No |
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Automatic Bilge pumps (number): 1 2 3 4 |
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Manual Bilge pumps (number): 1 2 3 4 |
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Ground Tackle |
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Primary Anchor: Plow (CQR, Delta) Fluke (Danforth) Claw (Bruce) Scoop (Rocna, Mantus, Spade...) |
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Size: kg lbs |
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Primary Rode: All Chain All Rope Rope/Chain Combo |
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Length: meters feet |
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Secondary Anchor: Plow (CQR, Delta) Fluke (Danforth) Claw (Bruce) Scoop (Rocna, Mantus, Spade...) |
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Size: kg lbs |
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Primary Rode: All Chain All Rope Rope/Chain Combo |
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Length: meters feet |
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Anchor Windlass: Yes No |
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Tools |
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Please detail what is on board: |
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Dinghy |
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Type: Inflatable Rigid hull |
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Outboard Engine: Yes No |
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If Yes, Horsepower: below 5 5 7.5 9.9 15 over 15 |
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Other |
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Date of last hauling out: January February March April May June July August September October November December 2015 2014 2013 2012 2011 2010 earlier |
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Date of last survey: January February March April May June July August September October November December 2015 2014 2013 2012 2011 2010 earlier |
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If sailboat, Age of standing rigging: 2015 2014 2013 2012 2011 2010 2009 2008 2007 2007 2005 older |
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Insurance |
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Hull Protection and Indemnity Clause: Yes No |
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Insurance Company name: |
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Policy Number: |
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Towing Insurance: Yes No |
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If Yes, Contact Name: Contact number: |
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