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Claim Form

Claims can happen – that’s why you have purchased marine insurance. When something goes wrong our goal is to ensure that every claim is settled quickly and fairly. Should you have any questions or concerns during the claims please don’t hesitate to contact us.
More information on what to do if you have a claim and the claims process.

Personal Information
Name of Insured
Policy Number
Home Number(xxx) xxx-xxx
Business Number (xxx) xxx-xxxx
Address
City
Email Address
Operator Information
Operator Name
Age
Address
Home Number(xxx) xxx-xxx
Years of Boating Experience
Vessel Information
Vessel Year
Make
Length
Colour
Motor
Serial Number
Current Location
Accident Information
Location of Accident
Part(s) of Vessel Damaged
Date of Loss
Time (hh:mm)
Vessel on route from
Vessel on route to
Weather
Sea Conditions
Tide
Wind
Force
Other Vessel Information
Owner Name
Owner Address
Owner City
Owner Telephone Number(xxx) xxx-xxx
Operator Name
Operator Address
Vessel Year (yyyy)
Vessel Make
Vessel Length
Vessel Colour
Location of Vessel
Part(s) of Vessel Damaged
Name of Insurance Company
Policy Number
Person(s) Injured on Your Vessel
Name
Address
Types of Injury
Name
Address
Types of Injury
Person(s) Injured on Other Vessel
Name
Address
Types of Injury
Name
Address
Types of Injury
Witnesses
Name
Address
Telephone (xxx) xxx-xxx
Name
Address
Telephone(xxx) xxx-xxx
Accident Description
Operators full description of accident and subsequent events
Was either vessel in race?YesNo
Was “protest” lodged? YesNo
If protest lodged, outcome
Reported to authorities? YesNo
If yes, whom
If no, reason
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Northstar Marine Insurance Inc.
270-92 Caplan Ave, Barrie, ON, L4N 9J2
Phone 1-866-717-9295, Fax 1-866-354-7337
info@northstarinsurance.ca