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Owner's Information
Name
Home Address
Telephone
Email
Date of Birth
MM slash DD slash YYYY
Watercraft Information
Year
Length
Make
Model
Engine
# of Engines
Engine
YR/MFG
HP
Trailer?
Yes
No
VHF?
Yes
No
Radar?
Yes
No
Loran/GPS?
Yes
No
Depth Sounder?
Yes
No
Other
Halon?
Yes
No
Other
Vessel Location
Lay Up (Months)
LAY UP (LOCATION)
Ashore
Afloat
Private Pleasure?
Charter?
Live Aboard?
Paid Captain or Crew?
Yes
No
Navigational Area
Has Vessel Been Surveyed?
Yes
No
Date of Survey
MM slash DD slash YYYY
Operator
Years Experience
Prior Owned Vessels
Is there any other operator?
Yes
No
Comments:
Disclosure:
Boat insurance provides physical damage coverage to repair your boat if damaged or destroyed by a covered peril such as collision, fire, theft, windstorm, lightning or vandalism. A Boat Insurance policy can provide physical damage coverage on an Actual Cash Value (ACV) or an Agreed Amount Value basis.
I understand that filling out and submitting this form DOES NOT bind coverage in any way, and the only way coverage can be bound will be when I am informed of a binder or policy is issued by the agent representing me.
This field is for validation purposes and should be left unchanged.
This field is for validation purposes and should be left unchanged.
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About
Careers
Press Releases
Private Client
Business
Industries
Benefits
Personal
Contact
Get Quote
Client Portal
Report a Claim
Request Policy Change
Request Certificate
Request Auto ID Card
Pay Insurance Bill
Complete Review
Refer a Friend
info@nsigroup.org
Call 305.556.1488
Visit NSI Insurance Group on Facebook
Subscribe to the NSI Insurance Group RSS feed
Visit NSI Insurance Group on Instagram