BOAT / PLEASURECRAFT INSURANCE APPLICATION FORM

Please fill out the boat / pleasurecraft insurance application below to the best of your ability.  If you have any issues, please don’t hesitate to call us at 1-250-365-3368.  We will follow up after we successfully receive your submission.

    Owner(s) Full Legal Name (required)

    Date of Birth (required)

    Address/Postal Code (required)

    Occupation (required)

    Email (required)

    Phone (required)

    How did you hear about us?

    Operator(s) Experience

    Number of Years as Boat Owner (required)

    Length & Types of Boats Owned (required)

    Previous Insurer

    Expiry Date

    Has insurance ever been Declined or Cancelled?
    NoYes

    Provide Details

    Operator(s) Information
    Operator #1

    Name

    Principal Operator?
    YesNo

    Birth Date

    # of Years Operating a Boat

    Length & Type of Boats Operated

    Boating Courses Passed

    Operator #2

    Name

    Principal Operator?
    YesNo

    Birth Date

    # of Years Operating a Boat

    Length & Type of Boats Operated

    Boating Courses Passed

    Operator #3

    Name

    Principal Operator?
    YesNo

    Birth Date

    # of Years Operating a Boat

    Length & Type of Boats Operated

    Boating Courses Passed

    Operator #4

    Name

    Principal Operator?
    YesNo

    Birth Date

    # of Years Operating a Boat

    Length & Type of Boats Operated

    Boating Courses Passed

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

    Provide Details:

    Vessel Information

    Year (required)

    Make (required)

    Model (required)

    Length (required)

    VIN

    Date Purchased (required)

    Purchase Price (required)

    Current Market Value

    Vessel Hull ID Number

    Vessel Type (required)

    Hull Construction (required)

    Date of most recent survey (please attach copy of survey)

    Anti Theft Tracking System (actively monitored) (required)

    Tender/Dingy (required)
    YesNo

    Provide Details

    Trailer

    Year

    Make

    Model

    VIN

    Value

    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

    inboard engine

    in-out engine

    outboard engine

    kicker engine

    jet engine

    Number of Main Engines (required)

    Type of Main Engine (required)

    Main Engine #1 (required)

    Year

    Make

    Model

    HP

    Max Speed

    Serial Number

    Fuel Type

    Outboard Purchase Price

    Current Market Value

    Main Engine #2

    Year

    Make

    Model

    HP

    Max Speed

    Serial Number

    Fuel Type

    Outboard Purchase Price

    Current Market Value

    Auxiliary

    Year

    Make

    Model

    HP

    Max Speed

    Serial Number

    Fuel Type

    Outboard Purchase Price

    Current Market Value

    Additional Information

    Private Pleasure use only (required)
    YesNo

    Live Aboard (required)
    YesNo

    Is it Moored (required)
    YesNo

    Provide Details

    Name of Marina

    Address

    City

    Postal Code

    Smart Plug (required)
    YesNo

    Security measures when boat is on the water

    Other security measures

    Security measures when boat is off the water

    Other security measures

    Primary Navigation (required)

    Layup Warranty: Is Pleasurecraft out of water November thru March? (required)
    YesNo