Owner(s) Full Legal Name (required)
Date of Birth YYYY-MM-DD (required)
Address/Postal Code (required)
Occupation (required)
Email (required)
Phone (required)
How did you hear about us?
Number of Years as Boat Owner (required)
Length & Types of Boats Owned (required)
Previous Insurer
Expiry Date YYYY-MM-DD
Has insurance ever been Declined or Cancelled? NoYes Provide Details
Name
Birth Date YYYY-MM-DD
# of Years Operating a Boat
Length & Type of Boats Operated
Boating Courses Passed Pleasurecraft OperatorPower SquadronMember of Cruising Club
Principal Operator? YesNo
Have any Owner(s)/Operator(s) had any losses or marine related insurance claims in the past 5 years? NoYes Provide Details:
Year (required)
Make (required)
Model (required)
Length (required)
Date Purchased YYYY-MM-DD (required)
Purchase Price (required)
Current Market Value
Vessel Hull Number
Vessel Type (required) PowerBoat OBSmall PowerBoatSki BoatWake BoatV-DrivePontoonBass BoatJet BoatOther
Hull Construction (required) FiberglassAluminumSteelWood PlankOther
Date of most recent survey YYYY-MM-DD (please attach copy of survey)
Anti Theft Tracking System (required) YesNo
Tender/Dingy (required) NoYes Provide Details
Year
Make
Model
VIN
Value
Inboard Propeller stays in water
In-Out Propeller can raise out of the water
Outboard Entire Engine is outside of hull
Auxiliary/Kicker Smaller motor for trolling/fishing
Jet Propulsion Boat is propelled by a stream of water ejected from motor
Number of Main Engines (required)
Type of Main Engine (required) InboardIn-OutOutboardJet
HP
Max Speed
Serial Number
Fuel Type
Outboard Purchase Price
Private Pleasure use only (required) YesNo
Live Aboard (required) YesNo
Is it Moored (required) NoYes Provide Details
Name of Marina
Address
City
Postal Code
Smart Plug (required) YesNo
Security measures when boat is on the water Private dockMoored on BuoyBoat is never stored on water Other security measures Security measures when boat is off the water Trailer Hitch LockTrailer Wheel LockLocked GarageGated PropertyBoat is never out of water Other security measures
Primary Navigation (required) InteriorCoastal
Owner(s) Full Legal Name: Date of Birth: Address / Postal Code: Occupation: Email: Phone:
How did you hear about us: Previous Insurer: Expiry Date:
Make: Model: Length: Year Current Value: Value of a new Unit: VIN Number Type of RV—Please choose an option—Travel TrailerFifth WheelTent TrailerCamper UnitPark Model
*We do not write class B
Usage: —Please choose an option—VacationFull-time TravelSnowbird (over 3 months)Full-time ResidenceFull-time WorksiteRented to others Any previous claims or losses? YesNo If yes, provide details: Any unrepaired damage? YesNo If yes, provide details: Loan? YesNo If yes, provide details: Skirted?YesNo Area of operation:CanadaUS and Canada
Secured parking - An RV Stored indoors, including garages and warehouses with locked gates/ and or doorswhile at home, in storage or not in use. OR permanently parked in a secure supervised RV parkRV Alarm – An alarm attached to and forming a part of the recreational vehicle that emits an audible alarmGPS Tracking – A GPS device attached to and forming a part of the recreational vehicle that sends a signal advising where the unit is located in real time.
Awning RC Extension Approx. $25CPL 2M Approx. $125 (Good to have for permanent residence)Increased Contents Approx. $15/$1,000Contents
Insurance Broker Toll Free: 1-800-663-4200 x 235 Direct Line: 250-980-3165 Email: kyamaoka@wvins.ca
Bookkeeper Toll Free: 1-800-663-4200 x 230 Direct Line: 250-980-3162 Email: pbiglow@wvins.ca
Insurance Broker Toll Free: 1-800-663-4200 x 229 Direct Line: 250-980-3166 Email: msommer@wvins.ca
Insurance Broker Toll Free: 1-800-663-4200 x 225 Direct Line: 250-980-3163 Email: dneaves@wvins.ca
Insurance Broker Toll Free: 1-800-663-4200 x 234 Direct Line: 250-980-3164 Email: schambers@wvins.ca
Insurance Broker Toll Free: 1-800-663-4200 x 223 Direct Line: 250-980-3160 Email: mhobal@wvins.ca
Branch Manager Toll Free: 1-800-663-4200 x 236 Direct Line: 250-980-3161 Email: nlychak@wvins.ca
