Add a Captain to Insurance Name* First Last Email* Phone*Date of Birth* MM slash DD slash YYYY Do you have any Violation/Suspensions (including Auto) in the last 5 years* Yes No Please explain the Violations/Suspensions*Years of Boat Ownership*Under 23-56-1011-1516-2021-2525+Years of Boating Experience*Under 23-56-1011-1516-2021-2525+Boating Qualifications (for example USCG 100 Ton)* Lengths and manufacturers of vessels previously owned or operated*Have you been involved in a loss in the last 10 years (insured or not)?* Yes No Insurance loss - Please give details and amounts paid*Have you ever been convicted of a criminal offence or pleaded no contest?* Yes No Criminal Offense, Please provide details* Δ