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Fawcett Insurance

North Vancouver Insurance - Servicing all your insurance needs

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Boat Owners Insurance

Your Details


List all accidents or claims in the past five years:


Date / Amount / Details
(full address)

Details of Vessel

DESCRIPTION


HULL

ENGINE (main)

ENGINE (aux)

TENDER

TRAILER

OTHER

YEAR


MAKE


MODEL


LENGTH / HP


SERIAL/VIN


(be specific)
(land storage)
(describe)




HULL & MACHINERY

OUTBOARD ENGINE

AUX. ENGINE

DINGHY / TENDER

TRAILER / BOATHOUSE

PERSONAL EFFECTS

PROTECTION & INDEMNITY

ORIGINAL PURCHASE PRICE


CURRENT MARKET VALUE


DEDUCTIBLE / RATE


I understand that the information set forth is correct and shall be the basis upon which insurance may be granted. Completion of this application does not bind the applicant to accept the quotation nor does it bind the insurer to accept the risk. The applicants agree that reports containing personal, credit, factual record, premium payment or claims history may be sought or exchanged in connection with this application for insurance or renewal, extension, variation or cancellation thereof.


PREMIUM IS FULLY EARNED – MINIMUM ANNUAL RETAINED

(Unless Watercraft is sold).

TALK TO A FAWCETT INSURANCE REPRESENTATIVE NOW!