Local & Worldwide
Yacht Insurance Coverage:
Obtain the Broadest Coverage
at the Best Price.
at the Best Price.
1 . 800 . 490 . 4058
fax 405 . 840 . 4655
fax 405 . 840 . 4655
WATERCRAFT QUOTE FORM - Complete and submit this form. We will respond with a quote within 48 hours.
Name to be used on Policy:
Phone Number: Email Address:
Email Address: Mailing Address:
City: State: Zip:
State: Zip: Beneficial Owner's Name: Date of Birth: (mm/dd/yyyy)
Date of Birth: (mm/dd/yyyy) Occupation:Nationality:
Nationality: Other entities or individuls having financial interest in this yacht:
Yacht To Be Insured
Year Built:Length:Manufacturer:
Length:Manufacturer: Type:Construction Material:
Construction Material: Tonnage: Total Horsepower: Fuel:
Total Horsepower: Fuel: Fuel Tank Material:
Engine Manufacturer:Engine Model:
Engine Model: Vessel Name:Effective Date of Coverage: (mm/dd/yyyy)
Effective Date of Coverage: (mm/dd/yyyy) Hull Insured Value: $Hull Deductible: $
Liability Limit: $Increased Personal Effects: $
Hull Deductible: $Liability Limit: $
Increased Personal Effects: $ Tenders (must be carried on board and used only to service the megayacht):
Year:Manufacturer:
Manufacturer: Tender Length:Horsepower:Value: $
Horsepower:Value: $ Personal Watercraft:
How Many? Year: Length: Manufacturer:
Year: Length: Manufacturer: Port of Registry:
Mooring/Navigating Area:
Home Port Spring/Summer: Home Port Fall/Winter:
Home Port Fall/Winter: Requested areas of navigation: (check all that apply)
One Year Itinerary:
Crew Information:
Total number of full-time paid crew: Total number of part-time/occasional paid crew:
Total number of part-time/occasional paid crew: Paid Crew Members: (check all that apply)
Captain's Name:
Loss/Survey Information:
Do you (the insurer) have any previous loss history?
If yes, please provide dates, description and amounts:
If yes, please provide dates, description and amounts:
Does the Captain have any previous loss history?
If yes, please provide dates, description and amounts:
Does the yacht have any previous loss history?
If yes, please provide dates, description and amounts:
Is a copy of the survey available?
If yes, you are required to provide us with a copy.
If yes, you are required to provide us with a copy.
Have all recommendations been complied with?
If you are not the original owner, what was the purchase date of the vessel? (mm/dd/yyyy)
(mm/dd/yyyy) Is a copy of the pre-purchase survey available?
Have all recommendations been complied with?
Original purchase price: $
Name of current/previous insurance carrier:
Names of previously owned vessels:
Has your insurance ever been non-renewed?
If yes, please provide details:
Loss Payee:
Name:
Mailing Address:
City:State:Zip:
State:Zip: Breach of Warranty required:
If yes, how much of loan? $
Additional Watercraft:
Year:Length:Manufacturer: Model:Value:
Length:Manufacturer: Model:Value: Year:Length:Manufacturer: Model:Value:
Length:Manufacturer: Model:Value: Are any of these watercraft towed behind the large yacht?
A quotation or policy issuance for this yacht is based upon inforamtion 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 binding coverage date.
(policy automatically provides $25,000 in Personal Effects Coverage)
