QUESTIONNAIRE

Boat/Personal Watercraft Insurance Questionnaire

If you have NOT completed the General Information Form, please do so before continuing with this or any quote request. Thank You.

BOATOWNERS/PERSONAL WATERCRAFT INSURANCE

*Applicant Name: *Co-Applicant Name:
WATERCRAFT INFORMATION
Type Year Make/Model Length Horsepower Boat Type Value
Boat
Motor
Trailer
Accessories

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CURRENT LIMITS AND DEDUCTIBLE
Bodily Injury Medical Payments Uninsured Boatowners Deductible Towing

List all accidents/violations/claims in the past three years. program hack item Muonline

Have you completed any boating safety courses? yesnoprogram hack item Muonline

Is boat stored in:
a locked enclosure (garage or building)
moored
other
If moored indicate marina, address and slip: program hack item Muonline

How long have you owned a boat? program hack item Muonline

Leinholder Name and Address: program hack item Muonline

Present Insurance Carrier: program hack item Muonline

Expiration Date of present insurance: program hack item Muonline

Date next payment due: program hack item Muonline

Do we write other insurance for you? yesnoprogram hack item Muonline

Submit...

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