Owner
Name:
Street Address:
City/State/ZIP:
Country:
Home Phone:
Work Phone:
Cell (mobile) Phone:
Email address:
Boat
Name:
Boat Type: Power Sail	Power Sail
Hull Type: Monohull Catamaran Trimaran	Monohull Catamaran Trimaran
Year:	2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 earlier
Make:
Model:
Bridge clearance:	Meters Feet
Boat Length:	Meters Feet
Beam:	Meters Feet
Draft:	Meters Feet
Boat Documentation or State Reg. Number:
Current paperwork aboard:	Yes No
VAT or Tax Certificate aboard: (Intl deliveries only)	Yes No
Engine
Manufacturer:	Yanmar Perkins Volvo Penta OMC Caterpillar Chrysler Cummins Mercedes Yamaha Johnson Mercruiser Evinrude Honda Other
Type:	Inboard Outboard
Number:	1 2 3 more
Fuel Type: Diesel Petrol	Diesel Petrol
Horsepower:
Fuel Capacity (gals):
Fuel Consumption: GPH
Cruising Speed (KnPH):
Range (nautical miles):
Manufacture year:	2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 earlier
Last service date:	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015 2014 2013 2012 earlier
Generator Yes No
Manufacturer:	Westerbeke Yanmar Perkins OMC Northern Lights Lugger Fischer Panda Onan Detroit Sabre Mercruiser Balmar Phasor Deere Other
Fuel Type:	Diesel Petrol
Size:	<5KW 5KW 7.5 <5KW 10KW 12KW >12KW
Manufacture year:	2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 earlier
Last service date:	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015 2014 2013 2012 earlier
Electronics / Navigation
VHF:	Yes No
SSB or HAM:	Yes No
Depth/SONAR:	Yes No
RADAR:	Yes No
GPS:	Yes, Chartplotter Yes, Just GPS No
AIS:	Yes, Receiver Yes, Transponder No
Auto Pilot:	Yes No
Wind Vane Steering:	Yes No
Systems
Inverter: No Yes, 110V Yes, 230V
Bow Thruster: No Yes
General
Water Capacity (gals):
Water maker: Yes No
Heating in Main Salon and Staterooms: Yes No
Air Conditioning in Main Salon and Staterooms: Yes No
Cooking/eating utensils on board: Yes No
Propane appliances on board: Yes No
Cooking fuel full: Yes No
Black water storage: Holding Tank Lectrasan None
Holding tanks pumped out: No Yes N/A
Accomodation
Staterooms: 1 2 3 4
Heads: 1 2 3
Shower: Yes No
Linens and bedding on board: Yes No
Safety
Adult Life Jackets (number): 0 1 2 3 4 5+
EPIRB: Yes No
If Yes, registered: Yes No
If Yes, date last inspected: January February March April May June July August September October November December 2015 2014 2013 2012 2011 2010 earlier
First Aid kit: Yes No
Fire extinguishers (number): 0 1 2 3 4 5+
In date Flares/distress signals: Yes No
Abandon Ship bag: Yes No
Horn: Yes No
Emergency steering: Yes No
Manual Bilge pump: Yes No
Automatic Bilge pumps (number): 1 2 3 4
Manual Bilge pumps (number): 1 2 3 4
Ground Tackle
Primary Anchor: Plow (CQR, Delta) Fluke (Danforth) Claw (Bruce) Scoop (Rocna, Mantus, Spade...)
Size: kg lbs
Primary Rode: All Chain All Rope Rope/Chain Combo
Length: meters feet
Secondary Anchor: Plow (CQR, Delta) Fluke (Danforth) Claw (Bruce) Scoop (Rocna, Mantus, Spade...)
Size: kg lbs
Primary Rode: All Chain All Rope Rope/Chain Combo
Length: meters feet
Anchor Windlass: Yes No
Tools
Please detail what is on board:
Dinghy
Type: Inflatable Rigid hull
Outboard Engine: Yes No
If Yes, Horsepower: below 5 5 7.5 9.9 15 over 15
Other
Date of last hauling out: January February March April May June July August September October November December 2015 2014 2013 2012 2011 2010 earlier
Date of last survey: January February March April May June July August September October November December 2015 2014 2013 2012 2011 2010 earlier
If sailboat, Age of standing rigging: 2015 2014 2013 2012 2011 2010 2009 2008 2007 2007 2005 older
Insurance
Hull Protection and Indemnity Clause: Yes No
Insurance Company name:
Policy Number:
Towing Insurance: Yes No
If Yes, Contact Name: Contact number:

 

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Spare parts list: Water pump impellers:

Drive belts:

Engine oil:

Fuel filters:

 

 

Owner/Operations manuals for all electronics and machinery: Yes No

Miscellaneous: Binoculars: Yes No

Spot Light: Yes No

Boat hook: Yes No

Flash lights: 0 1 2 3+

Harness: Yes No

Dock lines: Yes No

Passports (if visiting foreign port): Yes No

Any firearms on board: No Yes