Yacht Application


General Information

Date:
Your Name:
Your Email:
Vessel Name:


Agency:
Agency Code:
Name on Policy:


Mailing address:
City:
State:
Zip:


Occupation:

Yacht to Be Insured

Year Built:
Length:
Manufacturer:
Type:
Construction Material:
Total Horsepower:
Fuel Type:


Engine Manufacturer:
Engine Model:
Effective Date of Coverage:


Hull Insured Value:
Hull Deductible:
Liability Limit:
Medical Payments:
Personal Effects:
Uninsured Boaters:
Towing:


Tenders
(must be carried on board and used only to service the megayacht)
Year:
Mfr:
Length:
Horsepower:
Value:


Personal Watercraft
How Many:
Year:
Length:
Mfr:
Request for Charter:
Request for War:

Mooring/Navigating Area

Home Port:


Requested areas of navigation (check all that apply):

Other Locations:


Cargo Shipment Required:
Name of cargo carrier:
Shipment dates:
City of departure:
Arrival city:
1 Year Itinerary:

Crew Information

Total # of full-time paid crew:
Total # of part-time/occasional crew:


Please check all that apply
Captain:
First Mate:
Engineer:
Deckhand:
Chef:
Steward/Stewardess:


Captain's name:
Captain's Resume:

Captain's Loss History:

Loss/Survey Information

Any Loss History:
If yes, please provide dates, description & amounts:



Survey available:
If yes, please attach copy


Previously Owned Vessels:
Previous Insurance Carrier:

Loss Payee

Name:
Mailing Address:
City:
State:
Zip:


Breach of Warranty required:
If so, Amount of Loan:

Additional Watercraft

First Craft
Year:
Length:
Manufacturer:
Model:
Value:


Second Craft
Year:
Length:
Manufacturer:
Model:
Value:


Are any of these watercraft towed behind the megayacht?




If there is any additional information you'd like to add, please enter it below:



A quotation or policy issuance for this yacht is based upon information provided by the producer and prospective insured and is subject to receiving the Captain’s resume, the one year itinerary and a current survey (if applicable), within thirty (30) days from the quotation date.