Insurance Watercraft Application

INSURANCE WATERCRAFT APPLICATION

Applicant / Insured Information

Vessel Details

Engine / Propulsion

Trailer / Support Equipment

Use, Navigation Area & Storage

Primary Use: Recreational Waterskiing / Towing Fishing Instruction / Charter Racing Business Use

Navigation Area: Inland Lakes / Rivers Coastal Waters (specify limit below) Unlimited Coastal / Ocean

Safety Equipment

Required / carried equipment (check all that apply):
Life jackets (number: ) VHF Radio Distress Flares Fire Extinguisher Bilge Pump GPS Carbon Monoxide Alarm

Coverage Requested

Select coverages and specify desired limits, deductibles and annual premium estimates. Checking a coverage confirms you request underwriting consideration for that coverage.

Prior Insurance & Loss History

Has any watercraft insurance been cancelled or non-renewed in the past five years? Yes No

Prior Claims (provide details for any claims in last 5 years)

Exclusions & Limitations

Unless extended by endorsement and subject to applicable premiums, this application and any subsequent policy will exclude coverage for: (a) loss or damage due to ordinary wear and tear, gradual deterioration, mechanical or electrical breakdown except as caused by a covered peril; (b) loss resulting from intentional acts or willful neglect by any insured; (c) liabilities or losses arising from participation in professional racing, speed trials or timed events unless specifically endorsed; (d) pollution, contamination and radioactive contamination; (e) war, insurrection, seizure or requisition by civil or military authorities; and (f) any use for hire, commercial passenger carrying, or commercial salvage operations unless declared and accepted by the insurer. The insurer may impose additional terms, conditions or limitations based on vessel condition, navigation area, operator qualifications and prior loss history.

Beneficiary Designation

Designate one or more beneficiaries to receive any policy proceeds payable on total loss or salvage proceeds where allowed by law. Percentages must total 100%.

Declarations, Authorization & Certification

I certify that the information provided in this application is true, complete and correct to the best of my knowledge. I understand that any misrepresentation, omission or concealment of material facts may result in denial of coverage, rescission of policy or claim payment and may be a basis for cancellation. I authorize the insurer and its representatives to obtain underwriting information about the vessel, prior claims history, policy history and other relevant records from third parties including prior insurers, repair facilities and authorities. I understand the insurer may require physical inspection of the vessel prior to binding coverage or to investigate a claim.

By signing below I acknowledge receipt of the insurer's privacy notice as provided in policy documents and consent to the insurer's collection and use of personal information for underwriting, claims handling and fraud prevention consistent with applicable law. I further agree that any policy issued shall be subject to the terms, conditions, exclusions and endorsements contained in the policy form.

Fraud Warning: Any person who knowingly presents false information in an application for insurance may be guilty of insurance fraud and subject to civil and criminal penalties under applicable law.

Attachments & Documentation Checklist

Please attach copies of the following if available: vessel registration/documentation, purchase invoice or appraisal, recent photographs of vessel (port/starboard/stern/helm), engine records, prior policy declarations, and any repair invoices for recent major work.

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