VIP Marine Insurance Quote Form - Yacht Insurance

Marine Venture Group Boat & Yacht Insurance Quote Form

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

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