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Boat Insurance
Name:
Address:
City:
Province:
Postal Code:
(X1Y 2Z3)
Phone Number:
(123-456-7890)
Email Address:
(xxx@yyyy.zzz)
Age:
Policy Effective Date:
(dd/mm/yyyy)
Liability Requested:
$1,000,000
$2,000,000
$3,000,000
$4,000,000
Boat type:
Sailboat
Multi-Hull Sailboat
Open Runabout
Cabin Cruiser
Ski Boat
Houseboat
Trawler
Personal Watercraft
Other
Amount of insurance on boat:
Boat Manufacturer:
Year built:
Overall length:
Main motor:
None
Inboard/Outboard
Inboard
Outboard
Jetdrive
Other
Construction:
Fiberglass
Fiberglass over wood
Plywood
Wood Plank
Aluminum
Steel
Concrete
Other
Year of motor:
Type of motor:
None
Inboard/Outboard
Inboard
Outboard
Jetdrive
Other
Manufacturer:
Horsepower:
Maximum speed of motor:
Amount of insurance on motor:
Twin engine:
Yes
No
Trailer:
Yes
No
Year of trailer:
Make and model of trailer:
Amount of insurance on trailer:
Years operated:
Years owned:
Courses & Level Completed:
Loss details:
Has any company ever cancelled or refused insurance of this description?
Yes
No
Comments:
