Watercraft Claim Report
Name*
First Last
Policy number*
Best number to reach you - Daytime*
Best number to reach you - Evening
Your address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Current location of vessel*
Vessel year*
Make & Model*
Length*
Motor
Do you have any digital photos of the damage?*
Operator*

If the vessel was not in operation at the time of the loss, please enter "none" or "N/A"
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?*
In case of injuries, theft, vandalism, or any criminal activity, or collisions where the damage exceeds $1,000 or affects seaworthiness, report the incident to the appropriate authorities promptly. (In most cases your local police).
If yes, to whom?
Do you have any questions or concerns regarding the claim process?
Claim reported by*
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

Other Vessel

Important Notice

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