Yacht Questionnaire

Telephone Number:
 you must have at least one item
Home
Business
Cellphone

Yacht Information

 Persons, who will be operating yacht, including owner:
Name
DOB
Relationship
% of Use
Years of Experience
Vessel Type (Check One): *
 
Hull Material (Check One): *
 
 Yacht Details
Manufacturer
Year
Model
H.P.
Speed
Fuel (Check One): *
Equipment (Check all that apply and add if necessary): *
 
Paid Captain? *
Paid Crew? *
Is yacht used for Private Pleasure Only? *
Used for waterskiing? *
Chartered? *
Used for racing? *
Used as residence? *
Tender/Dinghy? *
 If yes,
Year
Length
Model
 Tender/Dinghy Motor:
Year
H.P.
 Dates Yacht will be laid up and out of commission:
Lay Up Location:
Lay Up Ashore or Afloat:
Number of Months of Navigation:
Has insurance ever been cancelled or refused? *
 Description of yachts previously owned:
Year
Make
Model
Length
Horsepower
Have you ever received citation for operating a vehicle or yacht in the last three years? *
Have you ever received a citation for operating a vehicle or yacht while under the influence of alcohol or other controlled substances? *
Boating Education and Training Courses (check one) *
 
If you have a loan, would you like "Breach of Warranty Coverage" (if available)? *
 Amount of Insurance Desired:
Hull and Motor Combined
Personal Effects/Personal Property
Fishing Equipment (Separate from PPL)
Liability Coverage (Limits of $100, $300,000, $500,000, $1m
Dinghy Limit