Boat / Yacht Insurance
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Contact Information
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Contact Number
Please enter a valid phone number.
Email
example@example.com
Address (Where boat is kept or owner's home)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Driver's License # and State
Occupation / Business Type
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Vessel Information
Boat Type:
Sailboat
Powerboat
Fishing
Yacht
Personal Watercraft
Commercial Charter
Other
Year / Make / Model:
Length (Feet) & Beam Width (Feet):
Hull Identification Number (HIN):
Hull Material:
Fiberglass
Aluminum
Wood
Steel
Other
Engine Type:
Inboard
Outboard
Inboard/Outboard
Other
Engine Make / HP & Number of Engines :
Maximum Speed (MPH/Knots):
Purchase Date & Price
Any modifications or custom equipment (if yes, describe)?
If trailer is included, please provide the following: Year / Make / Model / Value.
Fuel Type:
Gas
Diesel
Electric
Other
Usage Information
Primary Use:
Pleasure
Live-Aboard
Fishing
Charter
Commercial Work
Racing
Other
Typical Operating Waters:
Inland
Coastal
Great Lakes
Ocean
Other
Navigation Area & Average Hours Used Per Year:
Storage Location:
Marina
Private Dock
Dry Storage
Trailer
Mooring
Other
Is the marine stored at this location all year long or on specific months (mentions the months) ?
Boating Experience (Years Operating):
Security Measures:
Alarm
GPS Tracking
Lock System
CCTV
Other
Have you completed any Boating Safety courses (if yes, which course and year)?
Coverage Options
Hull Coverage Type:
Agreed Value
Actual Cash Value
Hull Coverage Amount:
Dollar value
Deductible:
$250
$500
$1,000
$2,500
Liability Coverage Limit:
$100K
$300K
$500K
$1M
Other
Click All The Coverages You Need:
Medical Payments
Uninsured Boater
Personal Effect
Towing & Assistance
Trailer
Fishing Equipment
Watersports
Pollution Liability
Crew Coverage
Other
History
Any losses, claims, or accidents in the past 5 years? Please provide when and price of claim.
Any prior insurance for this or other boats?
Any conventions or violations?
Is boat used for racing or charter for hire?
Yes
No
Additional Space:
Use the space to provide any information you feel is necessary.
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