Marine Insurance Inquiry Form

"*" indicates required fields

1Applicant Information

2Previous Insurance History

3Operator(s) Information

4Details of Vessel

5Coverage Limits

6Vessel Operations

Do you operate your boat primarily in British Columbia?

Harbord Insurance provides insurance options to boat owners who operate their boat primarily in British Columbia. If you have further questions about whether we are able to assist you, please call 1-866-203-8839.

Primary Owner Name*

First Last

Primary Owner Date of Birth

Occupation

Mailing Address

Address City State / Province / Region ZIP / Postal Code Country

Primary Phone*

Email*

Additional Owner(s)

Name of Owner	Date of Birth	Occupation	Address	Phone	Email	Actions

There are no Additional Owners.

Name of Vessel

Country purchased in

Year boat was purchased

This is the year you purchased the boat and NOT the year the boat was built

Purchase price

Coverage for transit from US required?

If Yes, from where?

Vessel Type

Hull Type

Engine Type

Max Speed

Please enter a number from 1 to 999.

Cruising Speed

Please enter a number from 1 to 999.

Survey?

Survey Date

Attach Survey

If an out of water survey has been completed within the last five years, please attach it here.

Accepted file types: pdf, doc, docx, Max. file size: 30 MB.

Hull

Make

Model

Year*

Length(in ft)*

Please enter a number from 1 to 999.

Serial Number

Engine (Main)

Make

Model

Year

Serial Number

Engine (Aux)

Make

Model

Year

Serial Number

Tender

Make

Model

Year

Serial Number

Trailer

Make

Model

Year

Length (in ft)

Please enter a number from 0 to 999.

Serial Number

Other

Make

Model

Year

Serial Number

Other Items

Refrigerator?

Refrigerator Fuel

Galley Stove?

Galley Stove Fuel

Heater?

Heater Fuel

Water Heater?

Water Heater Fuel

Unfortunately, due to the boat information provided we are unable to process your request online, please call us at 1-844-544-4663 and one of our friendly brokers will be able to help you.

Operator Name	Principal Operator?	Birthdate	Years as a Boat Owner	Years as a Boat Operator	Length of Boats Operated	Types of Boats Operated	Boating Education	Other Education	Actions

There are no Operators.