TheIndependentInsuranceAgency.com

We've Made Shopping For Any Kind Of Insurance Coverage Fast, Easy, and Available Online

    

                          Home | About Us | Contact Us | Applications & Forms

 

We offer Quick Quotes For Watercraft Insurance For Boats Less Than 32ft / Jet Ski Less Than 16ft

Are You Getting The Best Available Coverage & Rates ?

Do You Have A Motor Vehicle Record With Some Prior Tickets / Accidents / No Prior Insurance /Young Operators under 14 ?

If " Yes " Let Us Help You Get Insured Today

 

 

 Technical Support : 1-800-361-8734

American Reliable Insurance Company
 Click    To Get Underwriting Guidelines Need help with this question call 1-800-361-8734 !

Available To Texas Residents Only

      
  
                        Please Fill In All Fields To Get A Quick Quote.  
                                       
  BOAT OWNERS APPLICATION (LOB 89)  
   
 

Texas Residents Only

 
   
POLICY TERM

Requested Effective Date

   
Prior Insurance Carrier  Expiration Date 
   
NAMED INSURED (Registered Boat Owner - (Must be 18 years old or older)

First Name

          MI Last Name     Marital Status

Phone No.

Fax No.

                          Email Address     
Address City  State    Zip   
Garaging / Storing Location

 (including zip Code):

      Enclosed Storage Open Lot      

 

             

   

 

Address

City

  State                   County                    Zip

 

Special Waters Navigated (check all that apply)Need help with this question call 1-800-361-8734 !:

              Great Salt Lake 

AGENT -PRODUCER

Agent Tx License Number

Agency Name 

Phone No. 

 
Address City State  Zip 
WATERCRAFT OPERATORS Need help with this question call 1-800-361-8734 !

(No operator 13 years old or younger. Licensed operators must provide valid driver's license.)

Op #   - Name Of Operators

Date of Birth

SSN Drivers License # State Issuing # Yrs Boat Ownership / Experience Relationship to Insured Owner Owner/Operator Operator
1)  

2) 

3) 

4) 

         
MOTOR VEHICLE TRAFFIC VIOLATIONS / ACCIDENTS      PAST 36 MONTHS (ALL OPERATIONS) Need help with this question call 1-800-361-8734 !

       Click Here If No Violations / Accidents

  WATERCRAFT CLAIMS or LOSSES   In Past 36 MonthsNeed help with this question call 1-800-361-8734 !

Click Here If No Claims or Losses

Op #      Date            Explain Violation/Accident         Op #     Date             At Fault      Explain Watercraft Losses
 
 
 
 
       
LIEN HOLDER - FINANCE
Name

Loan #

               
Address

City  State    Zip   
DESCRIPTION OF WATERCRAFT - Maximum Length 32 ft.
Year Make Model Length

HIN #

 

If Other, explain Hull Material

Weight

   
Watercraft TypeNeed help with this question call 1-800-361-8734 ! Watercraft & Motor Value

(excluding Trailer)

                Current Value
Purchase Year Purchase Price (include motor)
    

 

SKI Boat  

$ $
DESCRIPTION OF MOTOR(S)
 
# Engine Type Fuel Type Year Make Model HP Serial #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIPTION OF TRAILER (Homemade Trailers are Prohibited)

Year

Make

Model

Serial Number

 

 
Label        

COVERAGES REQUESTEDNeed help with this question call 1-800-361-8734 !

 

   

WATERCRAFT LIABILITY

UNINSURED BOAT OWNERS (Uninsured Boat Owners limits must  equal or be lower than Liability Limits)

MEDICAL PAYMENTS

HULL COVERAGE

Current Market Value $   ( Claim Settlement Value Payable @ Time Of A Covered Loss)

 

Hull Deductible Options:

 If Watercraft < 16 yrs old ($250 minimum)

         
 

Hull Deductible Options

If Watercraft 16+  yrs old ($500 minimum)

 

   

PERSONAL EFFECTS

Misc. Equipment

 

$  

$100-$10,000

 

 - After  Deductible

TOWING

TRAILER

Value $  $250 to $10,000         

  Deductible Option:

Minimum Written and Earned Premium Is $100       

 

 

   
   
Label  

DISCOUNT / SURCHARGE SECTION Need help with this question call 1-800-361-8734 !

UNDERWRITING QUESTIONSNeed help with this question call 1-800-361-8734 !

Discounts that apply:   

Is the watercraft used in speed contests or racing (except sailboats), or designed and/or modified for racing?             Yes No  

Boat Safety Course / License: (Check all that apply)

Is this vessel equipped with a converted automobile engine, hydrofoils, or other apparatus that enable it to become airborne?              Yes No  

 

Is this vessel homemade, an experimental craft or a collapse able craft?Yes No  

 

Is the watercraft used as a residence?Yes No  

 

Is watercraft equipped with motors that exceed the manufactures recommended max. horsepower for hull design or the hull rating plate? Yes No  

Protective Devices:

Is watercraft a Ferro cement or iceboat , or is it under construction? Yes No  

 

Is the trailer not specifically manufactured for use as a boat trailer? Yes No  

 

Has any named insured or operator had their auto, watercraft or rec. vehicle policy cancelled, declined or non-renewed for underwriting reasons in the past 3 years? Yes No  

 

 

 

 

Is vessel chartered, used for any commercial or organizational usage, or rented/leased to others? Yes No  

Surcharges that apply:

Is the watercraft navigated in Mexico? Yes No  

 

Is the watercraft held for sale?  Yes No  

 

 

  

* See Underwriting Guidelines

 

Does the watercraft have existing damage?  Yes No  

 

None 1 Additional Owner

 2 3 4+

 

 

 

 

The named insured is a corporation for tax purposes.

 

 

 

 

 

 

None 2 3

 

 

 

 
Label        
 
Label        

INSTALLMENT BILLING OPTIONS  ( 30 % Minimum Down ) Monthly Payments Direct Bill 3   6 8

Full Pay 100% Down Two Pay 50% Down Four Pay 25% Down       ( 30% Minimum Down Payment Required )

 

REMARKS / COMMENTS :

 
Contracted Producers Please Complete This Section:
Agent / Producer - Name: Tx  License Number:

Address:

City:  

State: Zip Code:

Agent  Telephone:

Area Code Number

Fax : Area Code Number

Email:

DISCLOSURES/SIGNATURES

FAIR CREDIT REPORTING ACT NOTICE:  In compliance with the Federal Credit Reporting Act (Public Law 91-508), you are advised that the Company may order reports, which may contain or include information pertaining to the character, general reputation, personal characteristic, and mode of living of the applicant and/or other drivers listed in this application.  Upon written request, the complete nature and scope of the investigation will be provided.   

FRAUD WARNING:  Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claims containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and may subject such person to criminal and civil penalties.

PRIVACY POLICY:  I have received and read a copy of the American Reliable Insurance Company/Assurant Group Privacy Policy.  By submitting this application, I am applying for insurance and, at its expiration, for appropriate renewal policies issued by American Reliable Insurance Company.  I understand and agree that any information about me that is contained in, or that is obtained in connection with, this application of any policy issued to me may be used by American Reliable Insurance Company to issue, review, and renew the insurance for which I am applying.

I hereby declare to the best of my knowledge and belief that all of the foregoing statements are true and these statements are offered as an inducement to the Company to issue the policy for which I am applying.  I understand this policy may be cancelled if this application contains any false statement, omission, or material misrepresentation that would have otherwise altered the company's evaluation of the named insured.  I understand that motor vehicle records may be verified.

 

Insured's E-Signature (Enter Full Name Of Person Who Completed Above Application )        

Date Above Application Completed 

________________________________________________________________________     

 

 

American Reliable Insurance Company Policy Forms Are Mailed , Emailed , or Faxed Along With Each Quote We Provide

Note: These Sample Policy Forms Represent Current American Reliable Insurance Company Watercraft Policy Forms

Coverage proposals presented to you by our Agency may differ; as each insurer represented may offer modified coverage by endorsement or have filed it's own unique policy forms with the Texas Department Of Insurance. Please carefully read any carrier prepared proposal presented to you and where necessary request a copy of each insurance company policy and endorsement form presented; so that you may compare any differences in coverage offered.

 

 

Click    To Get Underwriting Guidelines Need help with this question call 1-800-361-8734 !