Watercraft Claim Report
Name*
First Last
Policy number
Best number to reach you - Daytime*
Best number to reach you - Evening
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Current location of vessel
Vessel year
Make
Length
Motor
Do you have any digitals photos of damage?
Operator
Operator's full description of accident and subsequent events*
Include name & address of any injured persons in description of accident.
Date of loss
MM slash DD slash YYYY
Time of loss
Accident/incident location
Other Vessel
Owner of other vessel involved
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Name of Insurance Company
Policy number
Was either vessel in race?
Was "Protest" lodged?
Reported to authorities?
If yes, to whom?
Do you have any questions or concerns regarding the claim process?
Please provide officer's name, badge number, police force and/or detachment & telephone number
Important Notice
1. Except at your own expense, you must not assume any obligation, admit any liability, authorize repairs or approve estimates without written consent.
2. Reasonable expenses you incur to prevent injury, minimize the loss or safeguard the insured boat are approved.
3. Refer to policy wording and/or contact Skippers' Plan / Arthur J. Gallagher Canada Limited at 1-800-661-7211 if you have any questions.

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Watercraft Claim Report