MARKEL®MARINE

RESUME OF PERSONAL BOATING EXPERIENCE

Please complete all sections

Name: ___________________________________________________________

Address: _________________________________________________________

City: _____________________________ State: ________ Zip: ________-_____

Driver’s License Number: ____________________________ State: __________

Date of Birth: ______/______/______

Occupation: ______________________________________________________

Years of titled boat ownership: __________

Prior boats you have OWNED:

Year

Length

Manufacturer

Model

Speed

(MPH)

Hours of

experience

Dates operated

(from year)

Dates operated

(from year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prior boats you have OPERATED:

Year

Length

Manufacturer

Model

Speed

(MPH)

Hours of

experience

Dates operated

(from year)

Dates operated

(from year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List all waters or areas you have navigated: (Atlantic, Great Lakes, Bays, Bahamas, Caribbean, etc.)

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List Licenses, Boating Courses, Boating Education Classes, etc. completed (if none, write None)

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List all marine insurance claims and/or prior marine loss history (if none, write None)

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I HEREBY AFFIRM THAT ALL STATEMENTS MADE HEREIN HAVE BEEN ANSWERED TO THE BEST

OF MY ABILITY AND ARE TRUE.  I UNDERSTAND THAT MARKEL AMERICAN INSURANCE

COMPANY IS RELYING ON THIS DOCUMENT IN THE UNDERWRITING OF THE POLICY.

 

Signature: _______________________________________________ Date: ______/______/______