| Bakes-Jarvie Insurance |
SMALL BOAT AND YACHT QUOTE APPLICATION FORM-- |
Completion of this form is for informational purposes only.
Only Availible in BC |
| APPLICANT INFO: |
| Name of Insured: |
Reg'd Owner: |
| Email Address: Preferred Contact Method: |
| Phone (Res): |
(Bus): |
| Postal Address: |
City: |
| Prov: |
Postal Code: |
Previous Insurer (This or prior boats):
Policy #: Expiry Date: |
No. Years as owner of Boat:
No. Years as operator/crew: Insurance Effective Date: |
| Size and type of previous boats: |
| Member of cruising club: |
| Have you ever had insurance refused or cancelled? |
Reason: |
Boating Education and Courses:
|
Boating Losses in past 3 years (Claimed or otherwise - Give date and description):
|
| COVERAGES - HULL AND MACHINERY |
| Make: |
Model: |
| Year: |
Length: |
| Replacement Cost New: |
Current Market Value: |
| Outboard/Auxiliary Motor: Year: Value: |
| DINGHY OR TENDER |
| Year: Value: |
| Dinghy Motor: |
| Year: Value: |
| ADDITIONAL PERSONAL EFFECT (to be listed seperately) |
| |
Value: |
| TRAILER |
| Make: Year: Value: |
| VESSEL DETAILS |
| Type of Vessel: |
Does Yacht Have:
|
Is Yacht of Fiberglass Construction?
Type of Fuel: Max Speed: |
Number of Engines: Manufacturer:
Total Horsepower: Type of Engine: |
| Navigational Limits Requested: Any Chartered use? |
| |
