CONDITION, RISK EVALUATION & VALUATION REPORT FOR MOORED BOATS TO BE CONDUCTED BY A QUALIFIED SURVEYOR POLICY/QUOTATION NUMBER OWNER ADDRESS EMAIL ADDRESS PHONE NUMBER VESSEL SPECIFICATIONS INSPECTION LOCATION DATE OF SURVEY TYPE OF VESSEL (MAKE/MODEL) HULL IDENTIFICATION NUMBER (HIN) (STATE) REGISTRATION / SAIL NUMBER BUILDER BUILT YEAR LENGTH BEAM DRAFT PLEASE ATTACH / INCLUDE PHOTOGRAPHS OF BOAT
HULL DECK & SUPERSTRUCTURE HULL CONSTRUCTION MATERIAL Exterior A/W Bulkheads Stringers Bilges Cockpit Coach-house Cabin/Interior Deck Superstructure Construction Winches & Deck Hardware Pushpit & Pulpit Stanchion, Life Lines & Fittings Cleats & Bollards Hatches Bimini / Covers Exterior U/W Keel & Keelbolts Anodes Anti-Fouling Propellers Shaft Sterngland Rudders Rudder Bearings Steering Linkages Auxiliary Steering Chain Plates Stemhead Fitting
POWER & PROPULSION MAIN ENGINES TYPE PETROL DIESEL INBOARD OUTBOARD STERN DRIVE JET MANUFACTURER YEAR OF MANUFACTURE MODEL NUMBER SERIAL NUMBER HP CAPACITY (L) ENGINE HOURS Installation Throttle Controls Exhaust Shaft Seal Fule Lines/Fittings Fuel Tanks Manifold & Shut Off Valves Filler Venting Connection & Lines Electrical Harness Electrical Fitting Stove Gas Bottles Gas Compliance Plate Number: Cooling System Batteries Mounting
MAST, SPARS, RIGGING AND SAILS IF NOT A MASTED VESSEL, TICK HERE MATERIAL ALUMINIUM TIMBER CARBON OTHER MAST TYPE MASTHEAD FRACTIONAL Mast Step Boom/s Rigging (Standing) Rigging (Running) Spreaders Base Attachments Chain Plates Hydraulics SAIL INVENTORY SAIL AGE SAIL CONDITIONS DATE MAST &/OR RIGGING LAST SERVICED & BY WHOM
ELECTRICAL SYSTEM Please provide an answer to each question and comments where appropriate. VOLTAGE ELECTRICAL DC ELECTRICAL AC BATTERIES BATTERY SWITCHES/PANELS CHARGING SYSTEM PLUMBING SYSTEMS WATER TANKS CAPACITY (L) FRESH WATER Pumps Accumulators Plumbing Hot Water Bilge Pump (automatic) Bilge Pump (manual) GREY WATER Showers Sinks Sumps Deck Wash Pumps
BLACKWATER Toilets Seacocks Blackwater Tankage ELECTRONICS & NAVIGATION EQUIPMENT Radios Navigation (GPS) Navigation Lights Cabin Lights Compass Weather Instruments Horn SAFETY EQUIPMENT Please provide an answer to each question and comments where appropriate. Life Jackets Fire Extinguishers Life Raft EPIRB Flares Fire Blankets / Smoke Detectors Anchor & Warp Stanchions/ Lifelines
VALUATION TOTAL SUM INSURED VALUE: DISCLAIMER RACV acknowledges that whilst all reasonable attempts have been made to uncover any defects, there may exist hidden or latent defects or those that cannot be discovered without interfering with the structure of the vessel. In consideration of the person or company to whom this form has been issued, carrying out a visual evaluation of the vessel on behalf of the owner of the vessel concerned, RACV undertakes not to instigate any legal proceedings or action against the person or company. RACV acknowledges that this document is to be used solely by RACV to evaluate the insurance risk and valuation of the vessel concerned and for no other purpose. For certain insurance products a Product Disclosure Statement is available from RACV Insurance which you should read before making decisions about those products. Insurance issued by Insurance Australia Limited, trading as RACV Insurance. REPORT TO BE CONDUCTED BY A QUALIFIED SURVEYOR: AUTHORISED MARINE SURVEYOR AUTHORISED SHIPWRIGHT AMSA ACCREDITED AIMS MEMBER BIA MEMBER RINA MEMBER IIMS MEMBER NAME SIGNATURE DATE BUSINESS NAME ABN EMAIL ADDRESS CONTACT NUMBER PLEASE ATTACH / INCLUDE PHOTOGRAPHS OF BOAT EMAIL COMPLETED REPORT TO: boatinsurance@racv.com.au Royal Automobile Club of Victoria (RACV) Ltd ABN 44 004 060 833 485 Bourke Street Melbourne VIC 3000 13 RACV (72 28) racv.com.au/marine