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Yacht Proposal Application

"*" 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

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)

Safety Courses Completed:

List and describe all prior marine losses, including dates:

Loss Type

Description

Date

Amount

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 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

Name

This field is for validation purposes and should be left unchanged.

Δ

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Yacht Proposal Application

Applicant Information

Yacht Information

Yacht Navigation Limits & Usage

Yacht Storage Information

Operator Information

Eligibility Questions

Loss Payee Information

Coverages and Premiums

Forms

Our Products

Commercial Fishing Vessels

Charter & Sportfishing Vessels

Yachts

Marine Artisans / Marina Operators

Aviation

Oil Pollution

Nets & Gear

Cargo

Aquaculture

Misc. Coverages

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