Marine Pleasure Craft Application

Please complete and submit this application form to receive your pleasure craft insurance quote. Fill in all fields, entering N/A if not applicable.

Primary Applicant - Full Name (Registered Owner)

Date of Birth

Occupation

Phone

Secondary Applicant - Full Name

Date of Birth

Principal Operator - Full Name

Date of Birth

Street Address

City

Postal / Zip code

Region/State/Province

How Many Years of Canadian Boating Experience Does the Applicant Have?

Has the Applicant Owned a Boat in Canada? (Yes/No), If Yes How Many Years and What Was the Length of the Largest Boat? (In Feet)

Member of Boating Club / Association? (Yes/No), If Yes, Provide the Club Name

How Many Boating Losses Has the Applicant Had in the Past 5 Years?

None

3 Or More

Claim / Loss 1: Date of Loss

Amount of Loss / Damage Paid

Claim / Loss 2: Date of Loss

Amount of Loss / Damage Paid

Claim / Loss 3: Date of Loss

Amount of Loss / Damage Paid

Has the Applicant Carried Insurance on a Marine Pleasure Craft in the Past 5 Years? (Yes/No), If Yes, Name Previous Insurer

Has Insurance Ever Been Cancelled or Refused?

Yes

How Many Minor Automobile Violations by the Applicant in the Last 3 Years?

None

3 Or More

How Many Major Automobile Violations by the Applicant in the Last 3 Years? (Impaired, Dangerous, Reckless, Excessive Speeding, etc.)

None

3 Or More

How Many At-fault Claims or Accidents by the Applicant in the Last 3 Years?

None

Select Vessel and Property Use

Strictly Private Pleasure Only – No Commercial/Rental Use

Some Commercial Use

Skippered Fishing Up To $20,000 Annually

Skippered Fishing Over $20,000 Annually

Other

Is the Vessel Used as Live Aboard?

Yes

Is the Vessel Canadian Registered/Licenced?

Yes

If You Have Indicated the Vessel is Not Registered / Licensed in Canada – Please Provide Details

The Applicant Hereby Attests That the Vessel Will Be Registered / Licensed as Required by Law Within 30 Days

Yes

Does the Vessel Have a Full Galley (Full Kitchen)?

Yes

Does the Vessel Have Full Height Standing Room in the Cabin?

Yes

Name of Vessel

Vessel Year

Year Purchased

Manufacturer

Model

Length (ft)

Total Horsepower of Main Motor(s)

Max Speed (As Per Manufacturer MPH)

Total Combined Purchase Price (incl. taxes) for Boat, Motor(s), Equipment + Trailer

Current Market Value - Vessel (incl. Main Motor(s) & Attached Equip.) (In CAD $)

Auxiliary / Secondary / Trolling O/B Motor (In CAD $)

Trailer (In CAD $)

Floating Boat Shed (In CAD $)

Boat Lift (In CAD $)

Auxiliary Motor Year

Auxiliary Motor Manufacturer

Auxiliary Motor Horsepower

Trailer Year

Trailer Manufacturer

Where is the vessel and property used? Select your requested navigation limits to be incorporated into the policy agreement. Select multiple if applicable. Do NOT skip this section.

ILR-1 (Inland Waters-Canada/Bordering US States): The navigable inland lakes and rivers of Canada, and the states of Washington, Idaho, Montana, North Dakota, Minnesota, Wisconsin, Michigan, Indiana, Ohio, Illinois, Pennsylvania, New York, Vermont, New Hampshire, Maine, and Alaska.

PAC-1 (Protected Coastal-BC/Washington): The navigable coastal waters of British Columbia and Washington state, but not outside of lines drawn between the following places: Cape Flattery and Owen Point; Cape Sutil and Mexicana Point; Cape James and Allison Harbour. In no event will the Insured Vessel be used in the coastal waters and Inlets of the West Coast of Vancouver Island between Owen Point

PAC-2 (Unprotected Coastal-West): The navigable coastal waters of the west coast of Canada but not north of Skagway, Alaska, and not west of Cape Spencer. In no event shall the Insured Vessel exceed 100 nautical miles offshore. The navigable coastal waters of Washington state but not west of Cape Flattery.

ATL-1 (Coastal-East): The navigable coastal waters of Eastern Canada and the United States but not north of 52°N and not south of 40°N. In no event shall the Insured Vessel exceed 100 nautical miles offshore.

Other: Not Described Above.

Vessel Location (Boating Season) - Street Address

City

Postal / Zip code

Region/State/Province

Vessel Location (Boating Off-season) - Street Address

City

Postal / Zip code

Region/State/Province

Loss Payable 1 – Name

P&I (Liability) Limit

$3,000,000

$5,000,000

Proposed Effective Date (MM/DD/YYYY)

Street Address

City

Postal / Zip code

Region/State/Province

Serial Number

Surveyed (Pease Attach)

Yes

Date Surveyed (MM/DD/YYYY)

Surveyor

Upload File

I understand that the information set forth is correct and shall be the basis upon which insurance may be granted. Completion of this application does not bind the applicant to accept the quotation, nor does it bind the insurer to accept the risk. The applicant agrees that reports containing personal, credit, factual records, premium payments, or claims history may be sought or exchanged in connection with this application for insurance or renewal, extension, variation, or cancellation thereof.

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