Marine Insurance Quote

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marine insurance Quote

Name Insured*
Date of Birth*
MM slash DD slash YYYY
If Corporate name, Beneficial Owner
Occupation
Phone*
Address*
Street Address City State Zip
Email*
State & Driver License Number*
Boat Year*
Boat Manufacture and Model*
Boat Length
Boat Value*
Year Boat Purchased
Engine Make, Model & Year*
# Engine & HP per motor*
Years of Boating Expierence*
Boating Courses*
- None
- U.S Power Squadron
- U.S Coast Guard Auxiliary
- Mariners License
- Captains License
Previously Owned Boats (make, length and years owned)*
Please list years owned, manufacturer, size and water navigated Example: 2 years, Sea Vee 34ft Florida & Bahamas
List of Other operators (Full Name, Age, Years expierence & DL #)*
Please list name, age, years of experience and driver license #
LIFE Time Loss History (if NONE, please state NONE)*
please list Details of loss, Date, Cause of loss, Amount Paid
Navigation/Safety Equipment/ Security (Mark all that apply)
- Radar
- EPIRB
- GPS
- Depth Finder
- Auto Pilot
- VHF Radio
- Theft Alarm
- Tracking Device
- Surveillance System
- Locked/fenced enclosures
- Secured Building
Trailer Make & Model
Mooring Location (Marina/Address, City, State, Zip Code)*

Please list all locations the boat will spend significant time at
Lay Up Dates (if applicable)

Ex: September - February
Boat Storage Method*
- Dock/Slip
- Trailer
- Lift
- Rack
- Other
Navigation Area*
- Florida
- Bahamas
- Gulf of Mexico
- East Coast U.S
- Other
please select the Navigational Area that the boat will be used in
Have you ever been convicted of a felony or DUI*
- Yes
- No
Has any carrier cancelled or non-renewed coverage?*
- Yes
- No