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Your information is on the yellow background form
The other parties information is on the pink background form
Police information is on the blue background form
The incident information is on the green background form
BOAT CLAIMS FORM
Date/Time of Incident 		TIME:
First Name
Initial
Last Name
Street Address
Apt. No.
City
Postal Code
E-Mail Address
Daytime Telephone Number
Evening Telephone Number
Policy Number
Insurance Company
Make and Model of Boat
Registration Number
Was there someone else involved???
Other Information
First Name
Init.
Last Name
Street Address
Apt. No.
City
Postal/ZIP Code
Daytime Telephone Number
Evening Telephone Number
Policy Number
Insurance Company
Reported to Police?
Please Check One
YES NO
Officer's Name
Badge Number
Occurance Number
Police Force/Detachment:
 (Opp, Halton, Metro etc.)
Charges Laid?
Incident
Information
Where did the
incident occur?
Details of Incident
Injuries?
Any other information that you think will be helpful.