Address/Postal Code (required)

How did you hear about us?

Operator(s) Experience

Has insurance ever been Declined or Cancelled?
NoYes
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Operator(s) Information

Have any Owner(s)/Operator(s) had any losses or marine related insurance claims in the past 5 years?
NoYes
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Vessel Information

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
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Trailer

Engines

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

Additional Information

Private Pleasure use only (required)
YesNo

Live Aboard (required)
YesNo

Is it Moored (required)
NoYes
Provide Details

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