Ambassador Ontario Insurance Brokers Inc.

QUOTES

Boat Insurance

Name:

Email Address:

Age:

Address:

City:

Province:

Postal Code:

Phone Number:

Policy Effective Date:

Liability Requested:

Vessel Type:

Vessel Manufacturer:

Year Built:

Overall Length:

Construction:

Main Engine:

Twin Engine:

Yes

Tender / Outboard / Trailer / Cradle:

Yes

Date Purchased:

Years Operated:

Price paid when purchased:

Present market value:

Estimate replacement (new) value:

Courses & Level Completed:

Loss Details:

Has any company ever cancelled or refused insurance of this description?

Yes

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