Personal InformationFirst Name *Last Name *Business Name Yacht is Held InStreet AddressCityState/ProvinceZIP / Postal CodeEmail AddressPhone *Do you prefer communication through What's AppYesNoDate of BirthMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212621252124212321222121212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926Watercraft InformationType of vesselYEARLENGTHMANUFACTURERMODELHULL MATERIALNAME OF YACHTHULL I.D. NO.PURCHASE DATEMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212621252124212321222121212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926PURCHASE PRICE $NUMBER OF ENGINESYEAR OF ENGINEH.P. EACHDINGHY INFORMATIONDINGHY YEARMFG AND MODELDINGHY LENGTHDINGHY MANUFACTURERENGINE YEARH.P.ENGINE MANUFACTURERNavigation and Storage InformationDESCRIBE ALL WATERS NAVIGATED AND MAXIMUM MILEAGE OFFSHOREMOORING ADDRESSLAY-UP LOCATIONVESSEL IS STORED (DURING SEASONAL LAY-UPASHOREAFLOATACCIDENT LOSS HISTORY:Have you ever filed a marine claim?YESNOIF YESLIST ALL MARINE INSURANCE CLAIMS YOU OR YOUR OPERATOR HAVE FILED REGARDLESS OF VESSEL INVOLVED (INCLUDING BODILY INJURY TO PASSENGERS OR CREW).Date of claimMonthDayYearDetails of ClaimAmount PaidSTATUSOPENCLOSEDCoverage InformationHULL VALUE REQUESTED(inc. engine(s) & electronics)Hull Value PremiumP&I$1,000,000$2,000,000$3,000,000$4,000,000$5,000,000Personal Effects - $10,000 *Coverage for all contents in the vessel. Can be customized higher by contacting your rep at Voyager Marine InsuranceYESNOMedical Payments - $10,000 *Can be customized higher by contacting your rep at Voyager Marine InsuranceYESNOUninsured Boater - $100,000 *Can be customized higher by contacting your rep at Voyager Marine InsuranceYESNOTowing - $1,000 *YESNODinghy ValueDinghy PremiumIndicationSubject to final underwriting, sailing resume, navigational limits, age of vessel, etc.$Credit / Debit Card *Submit
