Yacht insurance application

Burns & Wilcox Powersports Service Center +1.855.480.9763
Monday – Friday, 7:00 a.m. – 8:00 p.m. CST

Please note: There is no option to save the form, so please have all information ready when you begin. Detailed information about the boat and boating experience is required.

Fields with an asterisk (*) are required.

Agent information

Your full name

Phone number

Email address

Agency name, address, city, state, and zip code

Owner information

Multiple owners

Corporation or trust

Owner's full name

Date of birth

Residence address

City

State

Zip code

Marital status

Homeowner?

Yacht information

Year

Make

Model

Length (feet)

Hull type

Hull material

Max. speed (mph)

Number of engines

Total horsepower

Propulsion/Drive type

Fuel type

Is this vessel being used commercially?

Purchase year

Purchase price

Date of last Condition and Value survey

Yacht navigation

Where is the yacht used? (please provide specific bodies of water)

Yacht storage information

Name of in-season storage location

Location type

Address

City

State

Zip code

Is the yacht laid up in the off-season?

Lay up location type

Name of lay up location

Lay up zip code

Lay up start date

Lay up end date

Is the yacht afloat, ashore, or on a boat lift during the above layup period?

Is the yacht the owner's only residence?

Operator information

Primary operator's full name

Date of birth

In the last 10 years, how many years has the operator owned a similar yacht (similar means within 10 feet in length and like type)?

Description of most recently owned similar yacht (year, make, model)

Length (feet)

Number of years owned

Other experience: Please provide details (same as above) for any other previously owned yachts over the past 10 years.

Additional operators: Please provide same information as above (including date of birth) for each additional operator. If no additional operators, please list NONE.

Are any of the operators paid for their service?

List all marine losses and all motor vehicle violations and accidents for each operator. Include date, amount of loss, and description. If no prior losses, please list NONE.

Additional information

Does the owner have the yacht listed for sale?

Under the applicants ownership, has the yacht been uninsured in the past 30 days?

Has the yacht (including the engines) been modified or altered from its original stock condition?

Has any owner(s) or any operator(s) ever been convicted of a felony?

During the past 3 years, has any operator(s) had their drivers license suspended, revoked, or refused?

During the past 3 years, has any operator(s) had any boat or automobile insurance canceled, been refused insurance or renewal, or received notice of such intent?

Are there any owners that have not been disclosed?

If you answered Yes to any of the questions above, please explain:

Coverage and limits

Hull coverage (value of watercraft)

Deductible

Liability (will include uninsured boater and highest available pollution limit)

Liability only

Medical payments ($10,000 included)

Personal effects ($2,500 included)

Towing ($750 included)

Rental reimbursement ($1,000 included)

Fishing equipment

Boat trailer value

Tender value

Boat house value

Boat lift value

Current insurance provider

Current premium

Requested coverage date

Additional comments