Yacht Proposal Application

About the Owner
Insured's Full Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Applicant primary residence
Has the applicant moved in the last 60 days?
Phone (work)*
Email*
Occupation*
Beneficial Owner (if not the Insured)
Please list all beneficial owners and specify operators- only operators approved by us will be covered to operate vessels owned in corporate or trust names.
Is the titled owner different from the Primary Named Insured?
If so, who is the titled owner?
Length and nature of boating experience*
Give details, including qualifications and previously owned vessels.
Have you had any accidents, claims or losses in connection with any vessel you have sailed, owned or was under your control in the last 5 years?
Please provide full details, including dates and amounts paid*
Have you or any person you have allowed or may allow to use your yacht, ever been charged with or convicted of any offence involving dishonesty or any other offence which might affect our assessment of the risk?
Has any operator been convicted of a felony in the last 10 years?
Please provide full details*
Have you ever had Insurance declined, non-renewed or cancelled?
Has any applicant/operator had their license suspended, canceled, revoked, or barred within 36 months prior to the inception date of this policy?
Has the applicant had continuous insurance or a lapse of less than or equal to 31 days on any of the vehicles being quoted?
Please provide full details*
Names of other principal operators
Previous Insurers*
Policy Renewal Date*
MM slash DD slash YYYY
Disclaimers
In connection with underwriting or rating this application for insurance, we may review your credit history or obtain or use a credit based insurance score based on the information contained in that credit history. We may use a third party in connection with the development of your insurance score. In connection with this application for insurance, we may review your claims history or loss experience and may report future claims made by you to a claims history provider. In connection with this application for insurance, we may review your motor vehicle or driver history report. Disclaimer has been read and applicant did not object.*
In connection with underwriting or rating this application for insurance, we may review your credit history or obtain or use a credit based insurance score based on the information contained in that credit history. We may use a third party in connection with the development of your insurance score.

In connection with this application for insurance, we may review your claims history or loss experience and may report future claims made by you to a claims history provider.

In connection with this application for insurance, we may review your motor vehicle or driver history report.

Disclaimer has been read and applicant did not object.
I agree to the disclaimer.
Primary Operator Information
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Years Boating Experience*
Years of Boat Ownership*
Licensed Captain*
Prior Boats Operated*
Year Length Manufacturer & Model Name Dates Operated (from/to Month/Year) Owned? (Y/N)

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About the Vessel
Name Of Vessel*
Type of Vessel (eg. Motor Yacht)*
Date of Purchase
MM slash DD slash YYYY
Are any of the vehicle(s) being quoted offered for sale or consignment?
Manufacturer of Vessel*
Model of Vessel*
Year of Vessel Build*
Port of Registry*
Flag*
Class
Hull Identification Number
Price Paid*
Current Market Value*
Length*
Beam
Draft
Tonnage
Material of Hull*
Material of Mast*
Engines (make)*
Number & Horse Power*
Engine serial #(s)
Total Value of Yacht, Engine, & Equipment
Maximum Design Speed
Surface Drives
Trailer Year
Trailer Manufacturer
Trailer Model
Trailer Serial Number
Trailer Value
Tender Description
Tender Value
Has the Yacht been professionally surveyed in the last three years?
Last survey date?
MM slash DD slash YYYY
Surveyor's Name
Copy of the Survey
Max. file size: 50 MB.
Have all the survey recommendations been complied with?
Do any of the vehicle(s) have any unrepaired or existing damage?
Is the Yacht subject to finance or mortgage?
Please advise amount of loan and name of lender*
Details of fire extinguishing system
Is there a Vehicle Recovery or Tracking System on the vessel?
If so, what type?
Is the owner part of any boating associations?
If so, which one? AAA member?
Currency
- USD
- EUR
- GBP
Navigation Limits
Vessel Usage

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Use of Vessel
Details of use
- Private and Pleasure only
- Skipper Charter Use
- Bareboat Charter Use
Please specify number of weeks*
Are you going to live on the vessel? (i.e. live aboard)*
Racing or Regattas
Please provide details, including the values of the masts, spars, sails and rigging*
Mooring location Home Port - Spring / Summer*
Mooring location Home Port - Fall / Winter*
In Commission months
Lay up period
How often will yacht be trailered to Area of Use?
Times per year
Type of vehicle used to tow yacht
Make/model of vehicle
Will there be any towed vessels?
Please provide full details of period, name and location of shipyard*
Required cruising range*
If cruising East Coast US Waters below 35 degrees North a Hurricane Plan is required, please complete Yacht Additional Information Questionnaire.
Yard Period?
Please provide full details of period, name and location of shipyard
Owner / Skipper Information
Owner / Skipper Information
Name of owner / skipper Actions
There are no Owners / Skippers.
Maximum number of owners / skippers reached.
Driver’s License #
Crew Details (if applicable)
Number of Crew
Permanent Crew including Captain
Temporary Crew
Details of any U.S. Nationals
Captains Qualifications
Captains CV and License
Must be submitted to Underwriters for their agreement
Drop files here or

Max. file size: 50 MB.
Has the Captain had any accidents, claims or losses in connection with any vessel under their control?
Please provide full details*
Upload photo(s) of your vessel
Drop files here or

Accepted file types: jpg, gif, png, Max. file size: 4 MB, Max. files: 4.
Declaration
I declare that the information provided in connection with this proposal, whether in my own hand or not, is true and I have not withheld any material facts*. I understand that non-disclosure or misrepresentation of a material fact* may entitle underwriters to void the insurance.

*A material fact is one likely to influence acceptance or assessment of this proposal by underwriters; if you are in any doubt as to whether a fact is material or not you must disclose it.

This proposal and the information provided in connection therewith contain statements upon which underwriters will rely in deciding to accept this insurance. Should a contract of insurance be concluded this proposal will form the basis of the insurance.
Signature*
Name*
First Last
Date*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Name of owner / skipper	Actions

There are no Owners / Skippers.

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Year	Date of Loss	Amount Involved	Insurer	Amount of Claim

Step 1 of 4

About the Owner

Disclaimers

Primary Operator Information

About the Vessel

Coverages Needed

Additional Coverage

Use of Vessel

Owner / Skipper Information

Crew Details (if applicable)

Declaration

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Year	Length	Manufacturer & Model Name	Dates Operated (from/to Month/Year)	Owned? (Y/N)

Vessel	Home Port	Size of Vessel	Position Held	Dates