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Home » Our Forms » Yacht Insurance (Peace Team)

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General Information

Named Insured

Named Insured*

First Name* Last Name*

DOB*

MM slash DD slash YYYY DOB*

If Corporate, Beneficial Owner*

Occupation*

Address*

Street Address* City* State* ZIP Code*

Phone Number*

Cell Number*

Driver's License #*

State Licensed*

Email*

SS#*

Yacht Description

Year Built*

Length*

Manufacturer*

Model*

Hull Id #*

Name of Yacht*

State Registration*

Yes

Date Purchased*

MM slash DD slash YYYY Date Purchased*

Purchase Price*

Engine Model*

Registration #*

Type*

Use*

Construction*

Fiberglass

Wood

Aluminum

Kevlar/Carbon Fiber

Steel

Other

Registration*

Serial Number(s)*

Fuel Type*

Diesel

Gas

Fuel Tanks*

Metal

Fiberglass

Propulsion*

Engine(s)*

Horsepower*

Max Speed*

Auxillary Generator*

Diesel

Gas

Navigation/Safety Equipment/Security*

Auto Fire Ext.

Fume Detector

Radar

GPS

Depth Finder

Auto Pilot

# of Hand Held Fire Extinguishers

Engine Alarm

VHF Radio

Theft Alarm

Tracking Device

Surveillance System

Locked/Fenced Enclosure

Secured Building

Yacht Controller

Current Survey*

Yes

Three

Dock*

Afloat

Drydock

Date of Survey*

MM slash DD slash YYYY Date of Survey*

Name of Surveyor*

Current Mailing Address*

Street Address* Address Line 2 City* State* ZIP Code*

Email Address*

Contact Phone Number*

Effective Date of Coverage

MM slash DD slash YYYY Effective Date of Coverage

Training

Years of Boating Experience*

Boating Courses

None

Mariner's License

U.S. Power Squadron

U.S. Coast Guard Aux

Other Boating Courses

Boats Previously Owned

For every boat previously owned, please include: Dates owned, Manufacturer, Type, Size, and Waters Navigated.

Other Operators

For every other operator, please include: Name, Age, Experience, and Driver's License #.

Loss History

Please include details of any previous losses, including: Operators, Date, Cause, and Amount. If none, state NONE.

Have you ever been convicted of a felony or DUI?*

Yes

Yacht Tender Personal Watercraft Trailer

Year Built*

Length*

Manufacturer*

Model*

Hull ID #*

Engine Year*

Engine Manufacturer*

Engine HP*

Engine Serial #*

Stored on Trailer*

Yes

Trailer Year*

Trailer Manufacturer*

Serial #*

# of Axles*

Capacity*

Insurance Coverages Requested

Yacht Hull and Machinery - Amount of Insurance

Yacht Hull and Machinery - Deductible

Yacht Hull and Machinery - Named Windstorm Deductible

Tender & Outboard - Amount of Insurance

Tender & Outboard - Deductible

Tender & Outboard - Named Windstorm Deductible

Trailer - Amount of Insurance

Trailer - Deductible

Trailer - Named Windstorm Deductible

Liability (P&I) - Amount of Insurance

Liability (P&I) - Deductible

Liability (P&I) - Named Windstorm Deductible

Medical Payments - Amount of Insurance

Medical Payments - Deductible

Medical Payments - Named Windstorm Deductible

Personal Effects - Amount of Insurance

Personal Effects - Deductible

Personal Effects - Named Windstorm Deductible

Uninsured Boaters - Amount of Insurance

Uninsured Boaters - Deductible

Uninsured Boaters - Named Windstorm Deductible

Crew Liability - Amount of Insurance

Crew Liability - Deductible

Crew Liability - Named Windstorm Deductible

Navigation Area*

East Coast U.S.

Florida

Bahamas

Turks/Caicos

Gulf of Mexico

Caribbean

Mediterranean

Other

Lay Up Dates

From (Date)

MM slash DD slash YYYY From (Date)

To (Date)

MM slash DD slash YYYY To (Date)

Location

Ashore

Afloat

Mooring Locations: (Marinas/Address, City, State, Zip Code)

June 1 to November 30

Street Address Marinas City State ZIP Code

December 1 to June 1

Street Address Marinas City State ZIP Code

Storage

Dock/Slip

Trailer

Lift

Rack

Other

Lienholder Name

Lienholder Address

Street Address Address Line 2 City State ZIP Code

Loan #

Loan Balance

Additional Insured Name and Address

Other Information

Is yacht ever chartered to others with captain?

Yes

Remarks

If yes, is yacht owner operated?

Yes

Remarks

Is yacht ever chartered to others without captain?

Yes

Remarks

Is yacht used commercially or for business purposes?

Yes

Remarks

Do you employ a paid captain or crew? If so how many

Yes

Remarks

Do you live aboard full-time?

Yes

Remarks

Has any carrier cancelled or non-renewed coverage?

Yes

Remarks

Is the yacht used for racing?

Yes

Remarks

For fare paying passenger vessels, advise the maximum/average # of passengers per trip

# of trips annually

Boating License

Max. file size: 300 MB.

Additional Info

Max. file size: 300 MB.

Disclaimer*

I hereby declare that I personally have read this application and declare that the statements made are true. I understand that this is not a binder of insurance. Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime

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