Easy Boat / Yacht Insurance Application

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Quote Information
Occupation:	Date of Birth:
Years Boating Experience:	Years Boat Owned:
Boating Courses/Licenses:	Any claims in last 5 years:
Prior Boats Owned - Type, Size, Years Owned Most recent: Previous: Previous: Previous:
Vessel Information Purchase Price: Date of survey if available:
Hull Sail Power Make: Year: Model: Speed: Year Purchased: Length: Construction:
Engine Make: Year: Model: HP: Inboard Outboard I/O Other Diesel Gas Other Single Twin Other
Boat Equipment EPIRB Depth Finder Fume Detector VHF Radar Automatic Halon/CO2 GPS Loran Navigation Software (ie Capt'n) Other Equipment
Vessel Use Type of Use: Pleasure Charter Racing Commercial Navigation Area: Mooring Location: If laid up part of the year, from when to when: Where:
Paid crew?Yes No
Coverage Requested Hull and Machinery Limit: Deductible: P&I Liability Limit: 300,000 100,000 500,000 1,000,000
Current Insurance Company: Expiration Date: Current Premium:
Extended Navigation Details, Remarks, Other Coverage, and Loss Details
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