Safe Harbour Insurance
40 Industrial Park Rd Suite 301
Plymouth, MA 02360
800-508-7311 toll free
508-746-7990 voice
508-746-7991 fax

Marine/Boat Insurance Quotes

1. Full Name

2. Address

3. City
 State
 Zip

4. Email

5. Home Phone

6. Work Phone / Ext.:

7. OK to Call At Work? Yes No

8. Fax

9. Best Time To Contact

General Information

10. Type Of Hull

11. Hull Design

12. Hull Material

13. Type of Power

14. Year (ie. 1996)

15. Manufacturer/Model

16. Length

17. Max. Speed

18. Date Purchased (ie. 1996)

19. Cost New $

20. Present Value $

21. Waters Navigated

22. Berth Storage Location

23. Lay Up Period (list dry and afloat times)

Engine/Outboard Motor

24. Year (i.e. 1996)

25. Manufacturer/Model

26. Horsepower (MPH)

27. Fuel

28. Cost New $

29. Present Value $

Trailer Optional Coverage

30. Manufacturer/Model

31. Year Made

32. Cost New $

33. Present Value $

Coverage's/Limits of Liability

34. Hull

35. Outboard Motor (optional if not included in hull value)

36. Portable Accessories (state value)

37. Liability Coverage's

38. Equipment (check Yes or No)  
Bilge Pumps Yes No
Cooking Stove Yes No
Fume Detector Yes No
CO2/Chemical System Yes No
Fire Extinguishers Yes No
Depth Sounder Yes No
Radar Yes No
Radio Direction Finder Yes No
Ship To Shore Radio Yes No
Anti Theft Devices Yes No
Heating Yes No

39. Operators (list all residents and dependents (licensed or not) and regular operators

  Name Date of Birth Drivers License# Experience
1.
2.
3.
4.
40. General Information (check Yes or No to all)  
Is the boat chartered to others? Yes No
Is the boat used commercially or for business purposes? Yes No
Is the boat used for racing? Yes No
Is the boat used for water-skiing? Yes No
Does the applicant employ a paid crew? Yes No
Has the applicant lived at the current address less than 3 years? Yes No
Any operator have physical/mental impairments? Yes No
Any drivers license suspended during last 3 years? Yes No
Any operator have accident/conviction during the last 3 years? Yes No
Any losses occurred during the last 3 years? Yes No
Any coverage declined, canceled, or non-renewed during the last 5 years? Yes No
Any sleeping facilities? Yes No
If Yes, how many beds?

41. Questions and/or Comments

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Important Note: Quotes will be based on the information provided. It is only a rate calculation and is not binding in any way. A full application must be completed and signed by the named insured.