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Personal Information Consent

The personal information you provide in this webform will be used to present you with a quote, issue your insurance contract, if applicable, and support the services you receive. This personal information may be validated and reviewed, including your claims and policy history, and used in statistical models to calculate your insurance risk and premium.

The personal information you provide may also be pooled with information from other sources and subject to analysis for the limited purpose of preventing, detecting or suppressing fraud. For this purpose and to validate the information provided in this webform, information may be collected from or disclosed to:

i. fraud prevention organizations, including Équité Association, other insurance companies and the police; and

ii. databases or registers used by the insurance industry to analyze and check information provided against existing information.

If the information returned from these sources differs from what you have disclosed, the price and coverages offered to you may change, or your policy may be cancelled.

Your contact information will be used for quote follow up via email or a phone call from one of our client solutions managers. These purposes and our privacy practices and procedures are outlined in our respective privacy policies, as well as information about your privacy rights. Our privacy policy can be obtained at https://skippersplan.com/privacy-policy/. You may unsubscribe from our marketing emails at any time.

By clicking the ‘I Consent’ button below, you consent to Us collecting, using and disclosing the personal information you provide in connection with this webform and declare that you have obtained consent from the individuals listed in this webform for the collection, use and disclosure of their personal information, all as described above.

Personal Information Consent*

I consent*

Name of Owner(s) *

First Name*

First

Last Name*

Last

Company Name

Email Address*

Phone Number*

Primary Address*

Address Line 2

City**

Province*

Postal Code**

Country**

Different Mailing Address

Mailing Address

Address Line 2

City**

Province*

Postal Code**

Country**

Date of Birth*

YYYY dash MM dash DD

Watercraft

Year*

Enter Year*

Manufacturer *

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Manufacturer

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Manufacturer*

Example: Alumacraft

Enter Other Manufacturer*

Model *

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Model

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Model*

Example: Classic 165 CS

Enter Other Model*

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Horsepower and Drive

Example: 50 O/B

Length in Feet*

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Length UOM

Select the Type of Vessel*

Amount of Coverage Requested*

Value of boat, motor, equipment and trailer in CAD$ including all taxes

Hull Construction Type*

Hull Identification Number (HIN)

Vessel Registration or License Number

Speed in MPH

Does the Amount of Coverage include the value of the trailer?

Yes

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Speed UOM

Primary Engine

Description

Year

Horsepower

Serial Number

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Stern

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Coverage

Add Secondary Engine?

Secondary Engine

Description

Year

Horsepower

Serial Number

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Stern

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Coverage

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Tertiary Engine

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Description

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Year

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Horsepower

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Serial Number

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Stern

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Coverage

Add Auxiliary Engine?

Auxiliary Engine

Description

Year

Horsepower

Serial Number

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Stern

Value of Auxiliary Engine (CDN$ including taxes)

Add Additional Outboard?

Additional Outboard

Description

Year

Horsepower

Serial Number

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Stern

Value of Outboard (CDN$ including taxes)

Add Electric Engine?

Electric Engine

Excludes electric trolling motors

Description

Year

Horsepower

Serial Number

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Stern

Value of Electric Engine (CDN$ including taxes)

Additional Coverage Required

Add Trailer?

Trailer Description

Trailer Year

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Trailer Length

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Trailer Length UOM

Trailer Serial Number

Value of Trailer (CDN$ including taxes)

Add Dinghy?

Dinghy Description

Dinghy Year

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Dinghy Length

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Dinghy Length UOM

Dinghy Serial Number

Value of Dinghy (CDN$ including taxes)

Coverages

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Deductible

Are you the registered owner of the watercraft?*

Yes

Is the watercraft owned by 2 or more unrelated individuals?*

Yes

Is the watercraft owned or financed?*

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Leased

Lienholder Lessor

Is the watercraft registered or owned in a company name?*

Yes

Will the watercraft be used for commercial / business purposes?

Yes

Will the watercraft be used for entertaining clients or potential clients in connection with the applicant's profession/business*

Yes

Is the watercraft used to carry passengers or cargo for compensation of any kind, or for any other commercial or business purpose for compensation of any kind.*

Yes

Will the watercraft be used for charitable or volunteer purposes*

Yes

Will the watercraft be chartered or rented to others*

Yes

Do you employ a paid captain and/or crew?*

Yes

Will the watercraft be used in Atlantic / Pacific Coastal Waters?*

Yes

Is the watercraft stored in the same province as your residence?*

Yes

Does the watercraft have any existing or unrepaired damage?*

Yes

Is the watercraft currently for sale*

Yes

Have you had continuous watercraft insurance coverage for the past 12 months?*

Yes

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Convicted of Fraud

Applicant has been convicted of fraud with respect to any insurance coverage in the past 10 years

Number of watercraft claims in the last 6 years*

Present / previous watercraft insurer*

Present / previous watercraft insurer policy number

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Traffic Convictions

Any operator(s) have had any serious / criminal code traffic convictions in the past 3 years.

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Does the applicant want Guaranteed Replacement Cost?

Note: This coverage is not available for watercraft older than the current year, or with a unit type of "PWC".

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Insurance Denied

Applicant has had watercraft insurance claims denied, been declined for watercraft insurance, and/or been cancelled or non-renewed by an insurer in the past 5 years.

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The watercraft has been modified from the original design or specifications

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Will the watercraft be operated south of 40° N?

Yes

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Privacy Consent At*

YYYY dash MM dash DD

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The watercraft is used for racing

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The watercraft is equipped with a propane or natural gas heater or refrigerator, and the propane/natural gas system is shut off at the manually operated shutoff valve on the cylinder at all times when the watercraft is left unattended for more than 14 consecutive days

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Any operator(s) have had any driver's licence suspensions in the past 3 years

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Has the operator currently possesses a valid Pleasure Craft Operator Card?

Yes

Principle Operator

First Name*

Last Name*

Date of Birth*

YYYY dash MM dash DD

Has the operator completed an additional boat safety training course?*

Yes

Note: Pleasure Craft Operator's Card (PCOC) does not qualify.

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Drivers Vessel Year

The number of years experience this driver has had with this watercraft type.

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Primary Driver*

This driver is the primary driver

Personal Information Consent

Watercraft

Primary Engine

Secondary Engine

Tertiary Engine

Auxiliary Engine

Additional Outboard

Electric Engine

Additional Coverage Required

Coverages

Principle Operator

1.800.661.7211

1.800.661.7211