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Your Security is Our Business!

604-531-3599

reception@weeksinsurance.ca

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Boat Insurance

Name*

Email*

Phone*

Registered Owner of Boat:

Country/Region

Address

City

Zip / Postal code

How long have you owned the boat?

What is your occupation?

Do all operators have the following: Power squadron? Boating Education? Member of cruising club? Please outline:

Please list all operators of this vessel and their birthdates?

Any claims in the last 5 years? If yes, please state date of loss, amount paid out by ins. company and briefly outline what happened.

Please describe any past experience with boats? size/length of time, previous boats...

Vessel Manufacturer:

Vessel Model:

Length of Boat:

Boat Type

Jet Boat

Small Boat

Ski Boat

Runabout

Sail Boat

Power Cruiser

Higher Performance>60mph

Seadoo/Jet Ski

Fishing Boat (Non-Charter)

Fishing Boat (Charter)

Outboard

Jet Drive

How many main motors do you have?

Main Motor: Max Speed: Horse Power

Main Motor: Max Speed: Miles Per Hour MPH

Fuel Type

Diesel

Propane

Other

Fiberglass

Wood

Aluminum

Steel

Plywood

Other

When do you require insurance for this boat?

Is this the first time you insured this boat?

Total Purchase Price:

Date

Year

Month

Day

Current Market Value (Approx)?

Main Motor: Year: Make: Horsepower: Serial No.

Trailer: Year: Make: Serial No.

Does your vessel have a galley, head, or sleeping quarters?

List all auto moving traffic violations & at-fault accidents per operator (past 3 years):

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Weeks Insurance & Financial Services Inc.

101-2982 152 St.

Surrey, BC V4P 3N7

Phone

604-531-3599

reception@weeksinsurance.ca

Hours

Monday –Friday:

9:00 AM - 6:00 PM

Saturday:

9:00 AM - 5:00 PM
Sunday: Closed

New Emergency After-Hours Claims

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