Boat Insurance Quotation Request (including Jetboats)

Use this form to obtain a quotation for your Personal Pleasure vessel, Charterboat, Diveboat, Cruising boat, Jetboat, etc.

Basic Information

Are you an insurance agent or broker submitting this application on behalf of a client?

Please click here to go to a form submission for agents.

Primary Operator

Enter PRIMARY operators Family Name
Enter PRIMARY operators First Name
Where we send your mail.
or Address Line 3 if required
(if required)
or other address details if required.
USA or Canada. If not US or Canadian address ignore.

Vessel Registration Information

Is the boat or vessel (to be) registered in your name? If you are purchasing the vessel and if it will be registered in your name choose "YES".
Name of Beneficial Owner if owned by a corporation or LLC.
Where is vessel registered or flagged? If US Flagged/Documented or State/US Territory licenced vessel show USA.

Personal Information for Principal Operator

Date of Birth*
(MM/DD/YYYY)
*Optional information that may reduce your cost
*Optional information that may reduce your cost
Show your regular occupation here. If you are retired indicate your previous profession, e.g. Retired attorney
How many years have you operated boats? If less than 1 show 1.
How many years have you owned boats? If less than 1 show 1.
What type of training courses have you had in your lifetime?
Professional License
Do you have a Captain's License, RYA Skipper or other Maritime Rating or status? Check ONLY if you are qualified AT THIS TIME.
Please list Make & Length of a few boats you have owned &/or operated. Be specific and SHOW MAKE and LENGTH ONLY. For example- OWNED- Hunter 33, Morgan 42. OPERATED- Lagoon 44.
Do you have a copy of your license?

Please Read Carefully.

Select any of the following that apply (check box). For any checked boxes you will be asked for details.

Moving Traffic Violations
Please explain in detail - include year incurred and complete cirumstances.
Impaired Driving Convictions
Please explain in detail for each impaired driving conviction including year convicted.
Felony Convictions
Please explain in detail for each conviction including year convicted. Do NOT include misdemeanours.
Losses or Claims
Losses or claims of ANY type (insured or not). Please explain in detail for each claim, including year incurred, amount paid and insurer involved.
Cancellations or Non-Renewals
Please explain in detail for each cancellation or non-renewal including year incurred, reason for this action and insurer involved.
We may request additional information on those operators and if so, it will be in the same format as above.

Vessel Information

PRIMARY Vessel Use - what you use it mostly for. Some of these choices/questions are repeated below.
Captained or Crewed Charters
Check if YES - We gather more information later in this form.
Bareboat Charters
Business Purposes
Check if YES and provide details in REMARKS
Racing
Live Aboard YEAR ROUND
Check this box if this vessel is where you live aboard ALL YEAR ONLY.
Single Handed?
No other person onboard whilst underway

Vessel Details

(If Applicable)
$
USD please
$
USD please
Purchase Date
(MM/DD/YYYY)
Select boat type AND hull configuration
Vessel Make AND Model
Hull Identification Number - not necessary but nice to have.
LOA in Feet.
In Feet
Year hull built
Do you have a survey, no matter how old?
Survey Date
(MM/DD/YYYY) *We REQUIRE you to submit a copy of the most recent survey (age of the survey does not matter) if your boat was built earlier than 1985. Underwriters may request a survey if your vessel is not a standard production model.
Required only if you have a metal hull.
Is there a lienholder on your boat.You are required to providelienholder details prior to binding.

Engine Information

Year or last overhaul
Year or last overhaul
Year or last overhaul
Year or last overhaul
Top speed in MPH

Equipment List

NOT covered under H&M. You must list separately here.
Number of hand-held fire extinguishers
(manual and automatic)
Permanently installed units only.
Provide details in box below.

Vessel Activities

Do you allow water-skiing or other towing activities?
Do you allow SCUBA diving or snorkling?

Navigation Information

During the next 12 months for the period July 1 to November 1 will your yacht be located in the area between 12.30N to 23.40N and 55.0W to 85.0W and/or the Yucatan Peninsula &/or Cozumel, MEXICO? This area is sometimes reffered to as the Hurricane Box or Hurricane Zone.

The defined area is known to most Underwriters as the HURRICANE BOX or ZONE. We offer navigation and coverage iincluding and excluding the HURRICANE BOX or ZONE. We also offer coverage for Windstorms.
Advise vessel location or itinerary July 1 to November 1
If applicable, show marina name and include city/town, and state/province, zipcode or country.
For the next 12 months ONLY.
Where will the boat be laid-up?

Charter, Commercial Fishing, Commercial Vessels Only

For Charter, Commercial Fishing, Commercial Vessels ONLY, complete the requested information below. Otherwise click on Next below.

Enter number of years you have as a charter operator.
Estimated number of charters next 12 months
Maximum number of passengers for a single charter.
Average number of passengers on a single charter.
Do you supply water toys, kayaks, snorkel, dive or similar gear/equipment?

For Charter, Commercial Fishing, Commercial vessels ONLY if PAID Crew Coverage is required please complete the requested information.

Coverages Requested

If coverage not required enter "0".

Please indicate limits required in USD (US Dollars). Currency Converter Provided

Effective Date
Date you wish this policy to start (if known).
$
(USD Please). Also called Hull Value. This amount is usually equal to or less than the market value shown on your survey. If you request higher limits please give reasons in Remarks below.
$
(USD Please).
$
(USD Please). INCLUDE ENGINE
Enter dinghy make, model, and length (LOA)
Enter Dinghy Engine make, model or HP/KW
$
(USD Please)
Liability (P&I) Amount or Third Party Liability. Some limits may not be available. Liability offered may not be P&I. If you need more than 1 million USD please put amount in Remarks section below.
Please add your comments here to elaborate on information provided, to tell us more about your situation or explain coverage options you require.

Important note: Please review entire submission carefully before submitting this form as false information may void your insurance. Submitting this form does not bind you to purchase the insurance or any Insurer to accept the risk, however it is agreed that the information submitted shall be the basis of the quotation and contract should coverage be bound and/or a policy issued. No coverage is bound or in force until confirmed in writing by our office. The information collected from you is used to underwrite coverage and services. This information will be provided to others. The use of this website and our services indicates you agree with the terms contained in Important Information

By submitting your information you acknowledge and agree we may contact you by voice, facsimile or electronic means including but not limited to the review or discussion of your information and the distribution of promotional materials.

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