Yacht Insurance Questionnaire

Yacht Insurance Questionnaire
The application form that follows is aimed to generate information regarding your operation’s exposure to risk and guide underwriters to provide the best package of cover and terms available. Please complete all relevant sections in full as accurately as possible as this may form a part of your future contract.
Personal Information
Name

First NameLast Name
Age
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Date

MonthDayYear
Date
Start Date

DayMonthYear
Date
Items Insured
COVERAGES WILL NOT BE PROVIDED UNLESS REQUESTED HEREON

Please state the sum insured
HULL - PHYSICAL DAMAGE
TENDER/DINGHY
LIABILITY COVERAGE
CREW LIABILITY
OWNER OPERATOR M&C
MEDICAL PAYMENTS
UNINSURED BOATERS
PERSONAL PROPERTY
Non-Emergency Towing
Commercial Passenger Liability
TRAILER
Other
Vessel Information
Vessel Name
Year
Legnth
Date Purchased
Purchase Price
Present Value
Max Speed
Manufacturer/Model/Flag
Manufacturer/Model/Flag
Tenders or Dinghies
Stored At
Anti-theft precautions:
Waters to be navigated:
General Information
Please tick the boxes that apply to you

Is the boat charted to others with captain?Is the boat charted to others without captain?Is the boat used for racing?Is the boat used for water skiing or diving?Is the boat used commercially or for business purposes?Does the applicant employ a paid crew?Was the operator involved in a Marine loss in the last 10 years?Was any coverage declined, cancelled or non-renewed in the last 5 years?
Please explain all yes answers:
I confirm that this form has been completed accurately and that all material information has been given. Completion of this form is not binding by either party.
Should be Empty:

Yacht Insurance Questionnaire

Personal Information

Items Insured

Vessel Information

General Information