BOAT HULL NO: WATERCRAFT APPLICATION - …

acord 82 (2013/09)CIVIL UNION (if applicable) boat hull NO:HEATING# OF EXTINGUISHERSDATE LAST WEIGHEDSIZEDESCRIPTIONTYPEY/NEQUIPMENT TYPE# OF STOVES:FUEL TYPE:SPACES PROTECTED:MODELLIMITSERIAL NUMBERMODELMANUFACTURERYEAREQUIPMENTPORT ABLE ACCESSORIES AND LIFEBOATS / TENDERSMANUFACTURERRATING / UNDERWRITINGCOOKING STOVEFUME DETECTORAUTOMATIC?2CO / CHEMICAL SYSTEMSFIRE EXTINGUISHERSBILGE PUMPSDEPTH SOUNDERRADARRADIO DIRECTION FINDERSHIP TO SHORE RADIOANTI -THEFT DEVICESY/NEQUIPMENT TYPEThis field may not be utilized forpolicyholders applying for residentialproperty insurance in CA.*MARITAL STATUS * /BIRTH DATECO-APPLICANT'S OCCUPATION (State Nature of Business if Self-Employed)APPLICANT'S OCCUPATION (State Nature of Business if Self-Employed)SECONDARY E-MAIL ADDRESS:PRIMARY E-MAIL ADDRESS:PHONE #CELLHOMEBUSPRIMARYPHONE #SECONDARYCELLHOMEBUSDATE AT CURRENT RESIDENCE:APPLICANT'S NAME AND MAILING ADDRESS (Include county & ZIP+4)POLICY NUMBER:EFFECTIVE DATEEXPIRATION DATECARRIERNAIC CODEPLANFACILITY CODEFAX(A/C, No):AGENCYNAME:CONTACT(A/C, No, Ext):PHONESUBCODE:CODE:AGENCY CUSTOMER ID:ADDRESS:E-MAILDATE (MM/DD/YYYY) WATERCRAFT APPLICATION $$$$$$$$$$$$$$$$$$$FORM NUMBERFORM DATEPREMIUMDEDUCTIBLE$$$$$$$$$LIMITTOAPP LIESLIMITTOAPPLIESCODEUNIT #COVERAGEEA PER$$EA ACCEA ACCPDCSL / BI$$$EA ACCEA ACC$EA PERPDCSL / BI$N / A$$$$$$$$$$$$$$$$$$$$$$$EA ACCEA ACC$N / A$$AARCACVFORM NUMBERFORM DATEUNIT #TOTAL.

acord 82 (2013/09) civil union (if applicable) boat hull no: heating date last weighed # of extinguishers size description type equipment type y/n fuel type: # of stoves:

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  Date, Applications, Watercraft, Acord, Boat, Hull, Boat hull no, Watercraft application

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