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*
Years of Boating Experience*
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*

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