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Commercial Fishing Vessel Application


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Contact Information
First Name
Required
Last Name
Required
Mailing Address
Required
ZIP / Postal Code
Required
Phone Number
Required
E-Mail Address
Required
Client / Company Information
Vessel Name
Required
Corporate or Owners Name
Required
Address
Required
Present Insurer and expiration date
Required
Has insurance ever been denied or cancelled for this vessel?
Required
If yes, please describe
Optional
Vessel Information
Vessel Year
Required
Vessel Make & Model
Required
Vessel length / beam / draft (please specify)
Required
Vessel construction material
Required
Vessel official number / gross tons / where built (please specify)
Required
Date of vessel purchase
Required
/ /
Purchase price
Required
Engine year / make / model
Required
Number of engines and type (ex: twin inboards)
Required
Fuel type
Required
Engine Numbers (please specify, port & starboard)
Required
Generator Information (if applicable)
Optional
Additional Information
Please list all electronics, navigation, communication, and special equipment
Required
Loss Payee (if applicable)
Required
Homeport
Required
Type of fishing
Required
Waters navigated (including miles offshore)
Required
Layup period (if no layup please state so)
Required
Date of last survey & surveying firm
Required
Any other vessels owned or partially owned?
Required
Captain & Crew Information
Captain's name & date of birth
Required
List captains experience and licenses held
Required
Is coverage for other crew requested?
Required
If yes, Please list names and roles onboard
Optional
Losses in last 5 years?
Required
Coverage Being Requested
Hull & Machinery Coverage
Required
P&I (liability) Coverage
Required
Requested effective date
Required
/ /
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.




 
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