Unknown 1 C Unknown - Mon, Mar 15, 2010

Anderson Insurance Agencies Ltd.

"Serving the Kootenays Since 1946"
Now also Serving Alberta
An independent insurance broker covers you best
" An independent insurance broker covers you best "

Watercraft Insurance Quote Request

* Required Fields

First Name *
Last Name *
Address *
City *
Postal Code *
Phone (including area code) *
E-Mail *

Operator 1
Age Years Experience
Details of Previous Boats Owned
1. Do you hold a valid Watercraft Operator Card? Yes   No 
During the last 5 years:
1. Any losses and / or claims? Yes    No 
2. Insurance cancelled? Yes    No 
3. Auto accidents or convictions? Yes    No 
If yes, please describe below:

Operator 2
Age Years Experience
Details of Previous Boats Owned
2. Do you hold a valid Watercraft Operator Card? Yes   No 
During the last 5 years:
1. Any losses and / or claims? Yes    No 
2. Insurance cancelled? Yes    No 
3. Auto accidents or convictions? Yes    No 
If yes, please describe below:

Details of the Boat to be Insured

Boat Description
Year  Length 
Motor Description
HP   Year 
Max. Speed     Kph    Mph    Kts 
Where is boat stored or moored?
Do you have a power or sail squadron certificate? Yes  No 
Do you have any of the following?:
Stove? Yes    No 
Fridge? Yes    No 
Furnace? Yes    No 
If yes please describe fuel:
Do you live on board? Yes No
Do you race? Yes No
Hull is:
Fiberglass? 
Steel? 
Wood? 
Other? 
Boat Purchased: When? 

Cost?  

Do You Require?
Ocean use coverage Yes No
Business or Charter use coverage Yes No
Water-ski liability coverage Yes No

Amount of insurance required
Hull, Equipment & Machinery
Outboard
Trailer
Liability
Deductible

Other Comments



Last Modified: February 02 2010
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