| Basic
Yacht
Information |
|
The
Yacht Owner's Name |
|
| Yacht Owner's Date of Birth |
|
Occupation
|
Address
|
City
|
State
Zip Code
|
E-mail Address |
|
Please
Contact me by: |
|
Work Telephone |
|
Home Phone |
|
| Vessel Details |
|
Description
of Your Yacht |
|
|
|
| Length
|
Model
|
| Maximum Speed
|
Total Horsepower
|
Registration Doc# |
|
| Type
|
Contruction
|
| Date Purch
|
Purchase Price
|
Your Yacht
Engine Manufacturer/Model |
|
| Year Built
|
Fuel Type
|
Vessel Power Type
(Motor) |
Engine(s)
|
| Your Current Insurance Carrier |
|
| Current Insurance Expiration Date |
|
| Personal Data |
|
| Years Ownership Experience
|
Years Operating Experience
|
Previously Owned Vessels
(Size
& Type) |
|
| Boating Courses Completed |
|
Loss History
(Include Dates,
Cause and Amounts) |
|
| Other Operators |
|
| Name
|
D.O.B.
Experience
|
| Occupation
|
Boating Courses
|
| Name
|
D.O.B.
Experience
|
| Occupation
|
Boating Courses
|
| Navigation |
|
| Your Vessel's Navigation Area |
|
| Include the Bahamas in this area? |
Select one
|
| Lay Up From
To
|
Lay Up Type:
Afloat
Ashore |
| Your Vessel's Home Port? |
|
| Exact Mooring Location? |
|
| Navigation & Safety Equipment |
Please Check All That Apply |
VHF Radio
Loran/GPS
Compass
Auto Pilot
Depth Finder
Halon/Co2
|
Anti Theft Devices
Radar
Sat Navigation
Fume Detector
Other
|
| Dinghy/Tender |
|
| Dinghy Manufacturer |
|
| Length of Dinghy
|
Purchase Date
Price
|
| Dinghy Outboard Manufacturer |
|
| Dinghy Outboard Price |
|
| Dinghy Outboard HP |
|
| Trailer Model/Manufacturer |
|
| Tralier Year/Price |
|
| Survey |
|
| Current Survey
|
Date of Current Survey
|
| |
Survey Type
|
| Loss Payee Information |
|
| Mortgagee Name |
|
| Mortgagee Address |
|
| Miscellaneous Comments |
|
| Is this Yacht ever chartered to others? |
|
| If Answer is Yes, Please Explain |
|
| Is this Yacht used for commercial purposes?
|
Explain Please
|
| No. of Trips
|
Avg Number of Passengers
|
Do you employ a paid captain
or crew?
|
How Many?
Captains and/or
Crew |
| Has any carrier cancelled or refused yacht insurance?
|
Explain
|
| Is this Yacht used for racing?
|
|
| Requested Insurance Coverages |
|
| Yacht Hull and Equipment
|
Select Deductable
|
| *Dinghy Coverage
|
Included up to 16", 35 HP $5000
/ $100 Deductable |
| Trailer Amount
|
|
| Liability(P&I) Amount
|
*Medical Payment $10,000
|
| *Personal Effects$5,000
|
$250 Deductable |
| Uninsured Boater
|
|
| *Vessel Assistance/Towing $1000>>> |
|
| *Hurricane Haul Out
|
$500 Max per Occurance/$1,000
Max Aggregate |
| *Sails/Canvas Loss
|
Zurich will pay ACV, using 10%
depreciation as a "norm" for each year. |
| Sail Boat Club Racing Permissable?
>> |
|
| *Fishing Equipment
|
$5,000 Limit / $250 Deductable |
| *Electronics Deductable
|
$250 Deductable |
| Additional Comments / Questions |
|
