Watercraft

Name:
Email Address:
Age:
Address:
City:
Province:
Postal Code:
Phone Number:
Fax Number:
Policy Effective Date:
Liability Requested:	$1 million $2 million $3 million $4 million
Vessel Type:	Sailboat Multi-Hull Sailboat Open Runabout Cabin Cruiser Ski Boat Houseboat Trawler Personal Watercraft Other
Vessel Manufacturer:
Year Built:
Overall Length:
Construction:	Fiberglass Fiberglass over wood Plywood Wood Plank Aluminum Steel Concrete Other
Main Engine:	None Inboard/Outboard Inboard Outboard Jetdrive Other
Twin Engine:	Yes     No
Tender/Outboard/Trailer/Cradle:	Yes     No
Date Purchased:
Years Operated:
Price paid when purchased:
Present market value:
Estimate replacement (new) value:
Courses & Level Completed:
Loss Details:
Has any company ever cancelled or refused insurance of this description?	Yes     No
Additional Comments:
	Disclaimer