Alport Insurance Agencies Inc.
Boat quote Information Sheet
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Occupation
*
Phone Number
*
-
Area Code
Phone Number
Years as an owner
Years as operator
Other operators?
YES
NO
Other operators
Power Squadron
YES
NO
Pleasure craft card
YES
NO
# of Boat Claims in the last 5 years
Date, Type and amount paid for claim
Any Criminal code charges or convictions related to driving/boat?
YES
NO
Please describe the charge
Is there a loss Payable
YES
NO
Previous/current insurer
Coverage effective date
-
Month
-
Day
Year
Date Picker Icon
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
Age of Vessel
Fuel
Hull year, Make, model, length
Hull serial #
Main Engine year, make and horse power
Engine serial #
Aux Engine Year, make and horse power
Engine serial #
Trailer year and make
Vin #
Is there a Tender?
YES
NO
Year and make of tender
Is there a Current Survey?
YES
NO
Date of last Survey
-
Month
-
Day
Year
Date Picker Icon
Max Speed (mph)
Full time live aboard?
YES
NO
Stove?
YES
NO
Type of stove
Fridge?
YES
NO
Type of fridge
Pleasure use only?
YES
NO
Principally used where?
Moored
YES
NO
Moored where?
Security Measures
Land storage location
Original Purchase Information
Purchased in Canada
YES
NO
Purchased Date (Approximately)
Rows
ORIGINAL PURCHASE PRICE
CURRENT MARKET VALUE
Hull & machinery
Main Engine
Aux Engine
Trailer
Submit
Should be Empty: