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Person 1
Name
D.O.B.
VIOL
SS#
Driver's Lic #
-
-
Person 2
Name
D.O.B.
VIOL
SS#
Driver's Lic #
-
-
Person 3
Name
D.O.B.
VIOL
SS#
Driver's Lic #
-
-
Year
Make
Model
Hull ID#
# of motors on board
Total Horse Power
Current Value (cost to replace)
Zipcode Where Docked
Watercraft Use
Hull Material
Insured Property
Coverages
Liability Only
Phys Damage
Deductable 250 500 750 1000
U.B.
Med Pay
1000 2000 5000 10,000 /per person
Personal EFF.
Towing
(on water only)
Insured Address
parners
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