Boating Resume of Experience

Overview

This Boating Resume of Experience is an addendum to, and forms a part of the insurance application. One complete Boating Resume of Experience must be submitted for each named operator.

Operator Information

What is the operator's first name?

What is the operator's last name?

What is the operator's email address?

Please enter the operator's home address?

Street Address Address Line 2 City State ZIP Code

What is the operator's driver's license number?

Which state is the operator licensed in?

What is the operator's date of birth?

Boating Experience

Years Boating Experience

How many years of boating experience does the operator have?

Prior Boats Operated

Please provide the following information about previous boats operated. (Click the circle to the right of the table to add additional boats.)

Year	Length	Manufacturer	Model	Hull Type (Cat/V-Hull)	Dates Operated

Years Experience Owning Boats

How many years of experience does the operator have owning boats?

Previous Vessels Owned

Please provide the following information about any boats the operator has owned, including the current vessel(s). (Click the circle to the right of the table to add additional boats.)

Year	Length	Manufacturer	Model	Hull Type (Cat/V-Hull)	Dates Owned

Boating Course Selection

Please check the licenses, boating course(s) or classes for which the operator can present a certificate. (If they are not listed, select "Other" and enter them in the space provided.)

USCG (United States Coast Guard)
State Boating Course
USCG Aux
Captain License
ASA Sailing
Power Squadron
Sailing School
Other

Boating Course Other

Please enter the other licenses, boating course(s) or classes for which the operator can present a certificate.

Navigation Area

Please select the waters or areas the operator has navigated. (Select all that apply. If the waters or areas are not listed, select "Other" and enter them in the space provided.)

Other Navigation Areas

Please list all other waters or areas the operator has navigated. (I.e. Atlantic, Great Lakes, Pacific, etc.)

Any boating claims?

Has the operator had any boat losses? (Include all losses, whether or not an insurance claim was reported.)

Yes
No

Prior boat insurance claims history?

Please list all prior losses whether or not an insurance claim was reported.

Date	Description	Insurance Carrier	Amount Paid ($)

Statement of Fact*

I HEREBY AFFIRM THAT ALL INFORMATION INCLUCED HEREIN HAS BEEN PROVIDED BY THE UNDERSIGNED AND IS A TRUE AND CORRECT STATEMENT OF FACT.

I confirm

Signature of Applicant/Operator*

Signature of Applicant/Operator

Consent*

Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.

Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.

I agree

Boating Resume of Experience

Overview

Operator Information

Boating Experience

AJG (Ericson) Service

RiskRevu^TM Newsletter

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Boating Resume of Experience

Overview

Operator Information

Boating Experience

AJG (Ericson) Service

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