Insurance Watercraft Document

WATERCRAFT INSURANCE APPLICATION AND DECLARATION

Insured / Applicant Information

Date of Birth:    Phone:    Email:

Vessel Information

Year:    Hull Identification Number (HIN):    Registration #:

Length (ft):    Engine Make:    Horsepower:

Construction Material:    Primary Use: Pleasure Commercial Rental/Charter

Safety Equipment & Compliance

The undersigned represents that the vessel is equipped with the following required safety equipment (check all that apply):

U.S. Coast Guard approved life jackets for all persons aboard
Navigation lights in working order
Fire extinguisher(s) on board and serviced
Operational bilge pump
Visual distress signals / flares
Last safety inspection date:

Coverage Requested (select applicable)

Bodily Injury & Property Damage Liability
Limit: $    Deductible: $

Physical Damage (Hull) Coverage
Agreed Value / ACV: Agreed Value Actual Cash Value
Hull Limit: $    Deductible: $

Medical Payments Limit: $

Uninsured/Underinsured Watercraft Limit: $

Trailer Coverage Limit: $

Policy Details & Premium

Proposed Policy Period: From to

Payment Frequency: Annual Semi-Annual Monthly Method:

Navigation, Operational Limits & Use

Maximum distance from shore (nautical miles):    Typical number of passengers carried:

Exclusions, Conditions & Important Notices

1. Exclusions: Coverage shall not apply to loss or liability arising from (a) intentional acts or willful misconduct of the insured; (b) operation while under the influence of alcohol or controlled substances; (c) participation in organized racing or speed contests unless specifically endorsed; (d) wear and tear, gradual deterioration, or latent defects; (e) theft or loss when vessel is unattended without proper security unless theft report is filed within 24 hours. Additional exclusions may be set forth in the policy.

2. Conditions: The insured must maintain the safety equipment represented and shall permit reasonable inspection of the vessel by the insurer or its authorized representative. Failure to maintain material safety equipment or to permit inspection constitutes grounds for denial of a claim or cancellation for material misrepresentation.

3. Navigation and Use Restrictions: Any deviation from the stated navigational limits or authorized use that materially increases risk must be reported in writing prior to such deviation. Failure to report may void coverage for incidents arising during unreported operations.

4. Subrogation and Salvage: In the event of payment, the insurer shall be subrogated to the insured's rights against third parties to the extent of such payment. The insurer has the right to take charge of salvage and recovery operations and to pursue subrogation.

Beneficiary Designation (for medical payments / salvage proceeds if applicable)

Relationship:    Percentage:

Declarations, Representations & Certification

The undersigned certifies that the information provided in this application is true and complete to the best of the applicant's knowledge. The applicant acknowledges that any material misstatement, omission or concealment of fact in this application may be grounds for denial of coverage, rescission of the policy, or cancellation in accordance with the policy terms and applicable law.

The applicant agrees to notify the insurer promptly of any change in ownership, principal use, or navigational limits of the vessel and to pay any additional premium required for such change. Coverage under any policy issued in reliance on this application shall be subject to the terms, conditions, limitations and exclusions contained in the policy and any endorsements.

Claims Reporting: In the event of an accident, theft, or loss, the insured must notify the insurer as soon as practicable and provide a full written statement of the facts. The insured shall cooperate in the investigation, preservation of evidence, and any legal proceedings arising from a claim. Failure to report or cooperate may result in denial of claims.

Authorization

The undersigned authorizes the insurer or its representatives to obtain information reasonably necessary to evaluate this application, including but not limited to vessel inspection reports, prior insurance records, and pertinent loss history. The applicant authorizes release of such information to the insurer and understands such information may affect underwriting decisions.

Sign Now