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Quote Line: 1-800-330-3370
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Yacht and Boat Insurance
Yacht and Boat Insurance
Yacht and Boat Insurance

Atlass Insurance Group Yacht/Charter Boat Insurance Application

All items are required for completion, except where noted as optional (*)
Day Time Phone Email Address
Insured Information

Name:
Date of Birth:
Beneficial Owner:
(required if policy is in a company name)
Full Mailing Address:
Coverages Sum Insured:
Hull-Physical Damage
Liability Coverage
Vessel Information

Year:
 Length:
Date Purchased:
 Purchase Price:
Present Value:
 Max Speed:
Hull Identification Number: (*optional)
Manufacturer/Model:
Main Mooring/Storage Location Full Address:
Vessel Information cont.

Primary Power:
Sail
Outboard
Inboard
Inboard/Outdrive
Type of Vessel:
Sailboat
Motor Yacht
Sportsfisher
Cruiser
Performance
Houseboat
Hull Material:
Fiberglass
Steel
Aluminium
Wood
Kevlar
Carbon Fibre
Type of Hull:
Monohull
Catamaran
Fuel Tank:
Metal
Fiberglass
Waters to be navigated:
Vessel location July 1st - Nov 1st (including co-ordinates if known):
Engine/Outboard Motor Information

Engine: H.P.: Fuel: Manufacturer/Model:
1           Gasoline     Diesel
2           Gasoline     Diesel
3           Gasoline     Diesel
Operator Information

Operator #1
Name: (list insured, if operator)		 Date of Birth: Years of
Boat Ownership:		 Years of
Boating Experience:
Boating Qualifications:
Details of Previous Vessels Owned:
Operator #2 (*optional)
Name:		 Date of Birth: Years of
Boat Ownership:		 Years of
Boating Experience:
Boating Qualifications:
Details of Previous Vessels Owned:
Operator #3 (*optional)
Name:		 Date of Birth: Years of
Boat Ownership:		 Years of
Boating Experience:
Boating Qualifications:
Details of Previous Vessels Owned:
General Information

Is the boat chartered to others with captain:
         Yes    No
Have you or any named operator been involved in a marine loss in the last 10 years (insured or not):
         Yes    No
Was any insurance declined, cancelled or non-renewed in the last 5 years:
         Yes    No


Does the applicant employ paid crew:
         Yes    No
If so, how many:
        
Does anyone reside aboard the vessel:
         Yes    No
If you answered 'Yes' to any question above, please give full details:
[ Please Allow up To 15 Seconds for the Completion of This Form. ]
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