Personal Watercraft Insurance Form - Current Client

What is your first name? **

What is your first name? *

What is your last name? **

What is your last name? *

What is your email address? **

What is your email address? *

What is your phone number? **

What is your phone number? *

Please enter your home address. **

Please enter your home address. *

Street Address Address Line 2 City State ZIP Code

Do you have prior boating experience? **

Do you have prior boating experience? *

Yes
No

Primary Insured Years Experience

How many years of boating experience do you have?

Primary insured boats owned or rented

Please select the applicable option(s) below.

I have owned boats
I have rented/borrowed boats

Primary insured previous vessels owned

Please provide the following information about vessels you have owned.

Manufacturer	Length	Years Owned	Waters Navigated

Primary insured previous vessels rented

Please provide the following information about vessels you have rented/borrowed and were solely operated by you.

Manufacturer	Length	When Operated	Waters Navigated

Entity Ownership

Is there a Trust, LLC, or Limited Partnership involved in the ownership of this vessel?

Yes
No

Entity Name

What is the name of the trust, LLC, or Limited Partnership?

Other Owners/Drivers

Are there any other owners/drivers of this vessel?

Yes
No

Other Owner's Name and Experience

Please list the other owners / drivers and their boating experience.

Full Name	Years of Boating Experience

Vessel Information

New Purchase?

Is this vessel a new purchase?

Yes
No

Hull Value

What is the value of the vessel? (Ie. Insured amount)

Purchase Price

What is the purchase price?

Please upload a copy of the purchase agreement/bill of sale, if available.

Max. file size: 128 MB.

Boat Delivery Date

What date will you take delivery of the vessel?

Boat Coverage Effective Date

What date would you like coverage to be effective?

Boat Current Location

Where is the boat now? (ie. Marina, show room, etc.)

Delivery Transportation Method

Please describe how the vessel will be delivered to you? (Ie. Hauled on a trailer, etc.)

Vessel Description

Please provide the following information about your vessel.

Year	Make	Model	Length

What type of vessel is it?

Vessel type other

What type of vessel is it?

Will this vessel be used for water skiing, wake boarding, knee boarding or any other water sports?

Yes
No
Not sure

Max Speed

What is the vessel's maximum speed?

Hull Material

What material was used to construct the hull?

Hull ID Number

What is the hull ID number?

Engine Type

What type of engine does this vessel have?

Fuel Type

Please select the fuel type this vessel uses.

Gasoline
Diesel

Engine Count

How many engines does this vessel have?

Engine HP

What is the engine's horsepower? (Each engine, if multiple engines)

Engine Manufacturer

What is the name of the engine manufacturer?

Engine Serial Numbers

Please list the engine serial number(s), if available.

Financing

Is the vessel financed or leased?

Yes
No

Lien Holder Name

What is the name of the lien holder?

Lien Holder Address

What is the address of the lien holder?

Street Address Address Line 2 City State ZIP Code

Navigation Area

Please describe the waters that this vessel navigates. (I.e. Lakes, ocean, etc...)

Berthing Method

How will this vessel be berthed?

Dock Slip
Moored

Dock Address

Where will this vessel be docked?

Street Address Address Line 2 City State ZIP Code

Mooring Address

Where will this vessel be moored?

Street Address Address Line 2 City State ZIP Code

Stored at Marina?

Is your vessel kept at a marina?

Yes
No

Marina Name

What is the name of the marina?

Mooring Location Address

What is the address of the marina?

Street Address Address Line 2 City State ZIP Code

Marina Berthing Method

How is the vessel berthed at the marina?

Dock Slip
Moored

Please select where you keep your vessel when it is not being used.

Primary home address on a trailer
Secondary residence on a trailer
Boat storage facility

What is the address where your vessel is kept?

Street Address Address Line 2 City State ZIP Code

Is there a trailer?

Yes
No

Will you be registering the trailer?

Yes
No

What is the VIN (Vehicle identification number) for the trailer?

What is the value of the trailer?

Does this vessel have a lay-up period?

Yes
No
Not sure

How is the vessel stored during the lay-up period?

Ashore
Afloat

Please check the boxes of all the conditions below that apply to this vessel while it is laid-up.

The vessel is not navigated
The vessel is not ready for immediate use/The vessel is winterized
The vessel does not have anyone living on board
None of these apply

Do you have a marine survey for this vessel?

Yes
No

Please upload the marine survey here.

Please upload the marine survey here. (Optional)

Max. file size: 128 MB.

Vessel Usage

How will this vessel be used? (Select all that apply)

Water skiing, wakeboarding, water sports, etc.
Racing
Business
Charter
None of these

Racing Use Details

Please provide details about this vessel's racing exposure.

Business Use Details

Please provide details about this vessel's business usage.

Charter Use Details

Please provide details about this vessel's charter exposure. (Ie. How often it will be chartered, etc.)

Discounts

Please select the discounts you may be eligible for.

Coast Guard Boating Safety Course
Built-in Fire Extinguishing System
Alarm System
Full-time Captain
Stored in Hurricane Resistant Building

Any boating claims?

Have you had any boat insurance claims?

Yes
No

Prior boat insurance claims history?

Please enter information about any boat insurance claims below.

Date (Ex. May, 2019)	Claim Description	Amount Paid

Documents and Comments

Relevant Document Upload

Please use this field to upload any relevant insurance documents. (ie. Purchase agreement, current policy declarations pages, marine survey, etc...)

Drop files here or

Max. file size: 128 MB.

Please enter any additional remarks in the space below.

<font size="2" color="gray">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.*

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 *

Personal Watercraft Insurance Form - Current Client

Vessel Information

Documents and Comments

Barbara Targum

RiskRevu^TM Newsletter

Contact

Personal Watercraft Insurance Form - Current Client

Vessel Information

Documents and Comments

Barbara Targum

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RiskRevuTM Newsletter

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RiskRevu^TM Newsletter