Marine Vessel Insurance Survey Form
Provide vessel and operational details so the insurance survey can assess coverage needs and risk profile.
Vessel Information
Vessel Name
*
Vessel Type
*
Sailboat
Motor Yacht
Fishing Vessel
Commercial Cargo Vessel
Passenger Vessel
Other
Year Built
*
Length Overall
*
Hull Material
*
Fiberglass
Aluminum
Steel
Wood
Other
Current Home Port
*
Operation and Usage
Primary Usage Category
*
Private Leisure
Charter
Commercial Fishing
Cargo Transport
Passenger Transport
Other
Average Operating Area
*
Please Select
Inland Waters
Coastal Waters
Nearshore
Offshore
International
Estimated Annual Navigation Hours or Annual Voyages
Safety, Maintenance, and Insurance History
Maintenance condition rating
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Safety equipment checklist
*
Life jackets
Fire extinguishers
EPIRB/PLB
Navigation lights
Bilge pumps
Radar/AIS
VHF radio
Other
Recent incidents/claims history (past 5 years)
Rows
Year/Date
Incident Type
Loss Amount Range
Vessel Damage
Incident 1
1
2
3
4
Incident 2
5
6
7
8
Incident 3
9
10
11
12
Incident 4
13
14
15
16
Incident 5
17
18
19
20
Current insurance status
*
Currently insured
Previously insured
New application
Other
Additional notes on modifications, survey findings, or operational risks
Submit Survey
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