Yacht Insurance Proposal Application

Owning a yacht is a significant investment, and securing the right insurance is essential to protect it. At Pacific Ocean Marine Insurance Brokers, Inc., we simplify the process of obtaining comprehensive coverage through our easy-to-complete yacht insurance application. Whether you own a private vessel, a luxury mega yacht, or operate a charter yacht, our tailored policies are designed to safeguard your yacht, passengers, and crew. From physical damage and liability coverage to protection against environmental risks and personal belongings, we ensure your yacht is protected at sea and in port.

Applying for yacht insurance with us is quick and straightforward. Simply fill out our detailed application form, providing information about your yacht’s specifications, usage, and navigation areas. Once submitted, our experienced team will review your application and create a personalized quote that fits your needs and budget. With decades of expertise in marine insurance, we offer competitive rates and unmatched service, giving you the peace of mind to enjoy your time on the water.

"*" indicates required fields

Policy Period From:

MM slash DD slash YYYY

To:

MM slash DD slash YYYY

Named Insured:

Phone:

Fax:

Applicant Information

Primary Phone:*

Email Address:*

Date of Birth:*

MM slash DD slash YYYY

Marital Status:*

Residence:*

Owned

Rented

Copy of current condition and validation survey*

Max. file size: 50 MB.

Date of Last Survey*

MM slash DD slash YYYY

Vessels with an Out-of-Water Condition and Valuation Survey of 3 years or older may need to have a new survey performed before coverage can be bound.

Yacht Information

Hull Type*

Length*

Max Speed*

Hull Material:*

Fiberglass

Wood

Steel/metal

Glass over wood

Other

Unit Make:*

Year:*

Model:*

Serial/Hull ID:*

Purchase Date:*

MM slash DD slash YYYY

Purchase Price:*

Number of engines:*

Engine make:*

Year:*

Horsepower:*

Engine Serial:*

Total Value of Yacht, Engine, and Equipment*

Trailer year:*

Trailer make:*

Trailer serial:*

Trailer market value:*

Tender Description:*

Tender Value:*

Recent photograph of vessel*

Drop files here or Select files

Max. file size: 50 MB.

Photos of pontoons are required, showing the condition of the unit and that all gates are fully paneled.

Yacht Navigation Limits & Usage

Navigation Limits*

Usage*

Yacht Storage Information

Mooring Location Name:*

Mooring Location Type:*

Lay-Up Location Name (if applicable):

Lay-Up Location Type:

Lay-Up Location Zip:

Lay-Up Type:

Lay-Up Dates From:

MM slash DD slash YYYY

To:

MM slash DD slash YYYY

Operator Information

Primary Operator Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Years Experience with similar vessels in last 10 years (within 10' length and like type)*

Liscensed Captain

Yes

No

Prior Boats Operated*

Year

Length

Description of Boat Operated (Manufacturer and Model Name)

Total Years Owned and Operated

Owner (y/n)

Operator (y/n)

 

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Safety Courses Completed:

List and describe all prior marine losses, including dates:

Loss Type

Description

Date

Amount

 

Add Remove

Eligibility Questions

Is the yacht(s) up for sale?*

Yes

No

Has the yacht(s) not been insured anytime during the past 30 days?*

Yes

No

Has the yacht(s) (including the engines) been modified or altered from its original stock condition?*

Yes

No

Has any owner(s) or opertator(s) ever been convicted of a felony?*

Yes

No

During the past three years, has any operator(s) had their license suspended, revoked, or refused?*

Yes

No

During the past three years, has any operator(s) had any boat or automobile insurance cancelled, been refused issuance or renewal, or receieved notice of such intent?*

Yes

No

Are there any owners that have not been disclosed?*

Yes

No

Please explain:*

Loss Payee Information

Name

First Last

Loss Payee Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country

Coverages and Premiums

Coverage, Limit, and Elected Deductible:*

Applicant Signature*

Producer Signature*

Producer's License No. (required in Florida)

Date*

MM slash DD slash YYYY

Consent

I agree to the privacy policy.

List

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Comments

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