Boat Quote Form
Let’s start with your basic info
We will use this information to contact you about your quote. Your privacy is important to us. This form is encrypted to protect your data, and we will never share your information with third parties.
Date of Birth
*
-
Month
-
Day
Year
Date
Occupation
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Details of Operator
Years as Owner
*
Years as Operator
*
Size of Boats Operated ?WIP
*
Power Squadron
*
YES
NO
Please list any other operators
List all accidents and claims in the past five years
Any Criminal Code charges or convictions related to driving / boating
*
YES
NO
If Yes, describe:
*
Previous Insurer
*
Coverage effective
*
Loss Payable (full address)
*
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Details of Vessel
Vessel Type
*
In/Outboard
Outboard
Inboard
Sailboat
Jet Drive
Houseboat
Pontoon
Inflatable
Other
Hull Type
*
Fibreglass
Wood
Plywood
F/G Over Wood
Steel
Aluminum
Other
Component Details
*
Rows
Description
Year
Make
Model
Length / HP
Serial Number
Hull
Engine (Main)
Engine (Auxiliary)
Tender
Trailer
Other
Fuel
*
Stove Type
*
Fridge Type
*
Max. Speed (mph)
*
Livaboard
*
YES
NO
Pleasure Use Only?
*
YES
NO
Describe Usage in detail
Surveyed
*
YES
NO
When
*
Surveyor
*
Please attach survey documents
*
Browse Files
Drag and drop files here
Choose a file
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Details of Usage and Storage
Where principally used (be specific)
*
Where laid up (land storage)
*
Security Measures (Describe)
*
Type of anti-theft device used
*
Moored
*
YES
NO
Location
*
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Purchase Information
Purchased in
*
CAN
USA
Coverage for transit from US required?
*
YES
NO
From where
*
Purchase date
*
-
Month
-
Day
Year
Date
Component Specific Purchase Information
*
Rows
Original Purchase Price
Current Market Value
Deductible / Rate
HULL & MACHINERY
OUTBOARD ENGINE
AUX. ENGINE
DINGHY / TENDER
TRAILER / BOATHOUSE
PERSONAL EFFECTS
PROTECTION & INDEMNITY
PREMIUM IS FULLY EARNED – MINIMUM ANNUAL RETAINED (Unless Watercraft is sold)
Date
*
-
Month
-
Day
Year
Date
Signature (of Applicant)
*
Submit
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