- Yacht Insurance | Global Marine Insurance

One Water Yacht Group - Yacht Insurance Quote Request

First Name *

Last Name *

Primary Physical Residence *

City *

State *

Zip Code *

Mailing address (if different)

Date of Birth

Drivers License Number

Home Phone

Cell *

Fax

Email *

Marital Status *

Home Ownership Status *

Gender *

Year Built *

Length of Vessel *

Manufacturer *

Model *

Hull ID

Requested Effective Date *

Purchase date or financial loan closing date

Purchase Price (in USD)

Include taxes; title and registration fees

Number of engine(s) *

Maximum Speed (mph)

Horsepower each engine

Engine Type *

Hull Material *

Fuel Type *

Has the applicant previously owned other watercraft? *

Yes

If yes then fill in the following details.

If multiple watercraft, list largest to smallest.

Make(s)

Length(s)

Number of Years Owned

Has the applicant previously operated other watercraft? *

Including family, friends and rental boats.

If yes then fill in the following details.

Make

Length

Number of Years Operating

Any boating claims/losses within last five years? *

Yes

If you had a loss please provide the following details.

Date of Loss

Cause of Loss

Nature of Loss

Amount of Loss (USD)

Has the applicant or any operator had any vehicle driving violations in the past 5 years? *

Yes

(ticket, accident, felony, DUI)

If yes then tell us about the violation.

Operator Name

Violation Description

Date of Violation

Additional Experience, Claims or Violations?

If the applicant has owned more than one boat or has had additional claims or driving violations in the past 5 years provide details.

Mooring Address *

If marina or storage facility, please include the name of the business.

City

State/Territory