West Coast Global InsuranceServices

www.InsureMeWC.com

West Coast Global Insuranceprovides Boat & Yacht Insurance in the United States & Globally. Protect your vessel from Hurricanes in Mexico. Mexico Boat & Liability Insurance is also available in Mexico waters.

West Coast Global Insurance Services

Ca.Lic. #0E50745

USA - (818) 788-5353

Mex - 01 (800) 099 0614

Request Quote - West Coast Global Insurance provides Boat & Yacht Insurance in the United States & Globally. Protect your vessel from Hurricanes in Mexico. Mexico Boat & Liability Insurance is also available in Mexico waters.

IS THE REGISTERED OR OFFICIAL OWNER OF THE BOAT/YACHT AN INDIVIDUAL OR CORPORATION?

INDIVIDUAL
CORPORATION

INSURED DETAILS

BENEFICIAL OWNERS DETAILS

CONTACT DETAILS

I have Whats App? : Yes No

U.S. ADDRESS

ADDITIONAL DETAILS

Do you want to add a Lienholder? Yes No

Do you want to add any Additional Insured's? Yes No

VESSEL DETAILS

VESSELS FLAG: *

Hull Material *

FIBERGLASS
STEEL
WOOD
ALUMINIUM
CARBON
OTHER

ADDITIONAL FEATURES

Automated Fire Suppression System?

No
Yes

Anti-Theft Devices?

No
Yes

IPS Drives?

No
Yes

Jet Drives?

No
Yes

Surface Drives?

No
Yes

Arneson Drives?

No
Yes

GPS Tracker?

No
Yes

Pod Drives?

No
Yes
Add More Additional Feature

MOTORS/ENGINES

Select if your vessel has inboard or outboard engines/motors:

INBOARD MOTORS
OUTBOARD MOTORS

VESSEL/INSURANCE SUMS :- Vessel coverage limits entered here on this informal application are subject to change based on vessel programs and carriers accepting this risk in which you are applying coverage for.

Date of purchase or expected purchase date by owner:

If a recent purchase, please advise the fair market value as stated in survey (USD):*

Purchase Price(USD):*

Hull (USD): *

Trailer (USD):*

Life Raft (USD):*

P&I - (Liability):

Personal Effects(USD):*

Passenger P&I:

Fishing Tackle (USD):*

Crew P&I :

Medical(USD):*

Breach of Warranty (USD):*

Other (Please Specify)(USD):*

Add More Fields

 

TENDER/DINGHY

Do You Have a Tender or a Dinghy? *

No Yes

VESSEL LOCATION

Winter (Nov 2nd - July 14th)

Summer (July 15th - Nov 1st) Same As Above

NAVIAGTION LIMITS

Toggle all that apply to your navigation limits for this named vessel::

West Coast of the United States
California
West Coast of Mexico
Pacific Ocean – No more then 250 Miles off Shore
Sea of Cortez
Florida
South of Florida
Gulf of Mexico
Caribbean Sea
                     
Add More Navigation

WINDSTORM COVERAGE

Is the vessel located South of 30.5 degrees North latitude (South of Florida, the Gulf of Mexico, Caribbean Sea, West Coast of Mexico, including Baja &/or Southern Baja) during Hurricane Season (June 1st to November 15th)?

No Yes

Do you require Windstorm/Hurricane coverage? :

No Yes

OPERATOR(S)

How many operators with be navigating this vessel?

NON-OPERATIONAL PAID CREW

How many non-operational paid crew with be aboard this vessel?

PERSONAL USE ONLY / SKIPPER CHARTER USER

Will this vessel be for personal use only?

No Yes

Has the vessel ever been in a charter fleet?*

No Yes

Will the vessel be offered for charter for the term you are requesting coverage?*:

No Yes

Is the vessel chartered to others without a captain?

No Yes

Is the vessel used commercially or for business purposes?

No Yes

CLAIMS INFORMATION

Any claims in the last 10 years?

No
Yes

Any total loss in last 10 years?

No
Yes

UNDERWRITING QUESTIONS

1) Will the vessel be used to tow away any other vessel, except in case of an emergency?

No Yes

2) Is the vessel used for racing?

No Yes

3) Is the vessel used for water skiing or diving?

No Yes

4) Is the vessel ever operated single-handed?

No Yes

5) Will the vessel be laid up during the next 12 months?

No Yes

6) Has this vessel ever had an out of water valuation survey?

No Yes

7) Is your vessel currently insured?

No Yes

8) Have you had coverage declined, cancelled or non-renewed in last 10 years?

No Yes

A FEW MORE QUESTIONS TO UNDERSTAND THE SCOPE OF YOUR EXPSOURE TO RISK IN MEXICO?

1) I am interested in international life insurance to safe guard my family or business partner/s to pay off any outstanding loan on my property. (a medical exam may not be required – easy underwritting).

No Yes

2) I own vehicles in mexico?

No
Yes

3) I am interested in mexico & global travel health protection in the event of an accident or illness while i'm outside my country of residence for myself and or my family (air evacuation included).

No Yes

4) I live in mexico 6 months of the year or more and i would like to see options for expat major medical protection including air evacuation (global health protection with no borders- u.s. coverage included):

No Yes

5) I own or plan on purchasing a watercraft and would like to know more about watercraft insurance & liability protection in mexico. (california & global naviagational limits – ok):

No Yes

Include any additional comments for west coast global insurance services:

How did you hear about West Coast Global Insurance?

DIGITAL SIGNATURE

I acknowledge that West Coast Real Estate & Insurance, Inc., doing business as West Coast Global Insurance Services, does not guarantee any coverages and has presented this informal application/questionnaire solely for the purpose of collecting general information. I comprehend that the submission of this informal application/questionnaire does not constitute insurance coverage for either myself or the insured item for which I am seeking information.

I am aware that the coverage limits I have requested may be subject to change upon the generation of a formal quote by an insurance company. It is my responsibility to thoroughly review the coverages and policy conditions at that time. I confirm that I have read the foregoing application/questionnaire, along with any attached documents, and declare that the information provided therein is true, complete, and correct to the best of my knowledge and belief. I understand that this information serves as an inducement for the company to consider issuing an insurance policy, and no coverage is currently being offered.

I acknowledge that West Coast Real Estate & Insurance, Inc., DBA West Coast Global Insurance Services, will be in communication with me to further assist with my insurance needs. I hereby grant my consent to receive telephone calls, text (SMS & MMS) messages, and email communications. I understand that providing consent is not a condition of purchase, and standard message and data rates may apply. For more information on how your data is handled, please visit our Privacy Policy. (PRIVACY POLICY)
Checking this box serves as my digital signature.

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