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Download Claim Forms

Insurance Claim Forms

MS Word and Adobe PDF Forms

1. For Steps to Take in the Event of an Accident, Click Here .

2. Instructions to Complete the Claim Forms

  1. Marine Loss Notice
    1. Complete the Marine Loss Notice when reporting a new loss under the policy by an Insured Person under the contract or an insurance broker/agent. Be sure to complete fully.

  2. Owners/Operators Statement of Loss
    1. This form is to be used on all Boating Accident claims not involving theft. If theft, partial theft, or vandalism is the cause of the loss suffered, go to next step #2.

  3. Total Theft Affidavit/Partial Theft Affidavit
    1. The Total Theft Affidavit form is ts to be used if the Vessel, Trailer, or Dinghy is stolen. The Partial Theft Affidavit is to be used if anything is stolen from the Vessel, Trailer, or Dinghy.

  4. Inventory Form
    1. Use the Inventory Form to carefully list the items stolen from you. It is very important to complete fully, and attach the documents to verify ownership of the items claimed. For example, include receipts for purchase.

3. After you've completed the forms, please fax to Claims Department, fax (209-466-2344), email scanned documents to claims@aquapac.com, or surface mail them to

Westmar

Westmar
Claims Department
4226 Coronado Avenue
Stockton, CA 95204
or
Western Maritime

Western Maritime
Claims Department
4226 Coronado Avenue
Stockton, CA 95204


Marine Loss Notice
MS Word Format Adobe PDF Format


Owners/Operators Statement of Loss Form
MS Word Format Adobe PDF Format


Affidavit of Theft - Total Loss
MS Word Format Adobe PDF Format


Affidavit of Theft - Partial Loss
MS Word Format Adobe PDF Format


Inventory Form (Attach to Affidavits of Loss)
MS Excel Format Adobe PDF Format


Western Marine Insurance Services
4226 Coronado Avenue
Stockton, CA 95204

209/466-1413
800/633-3443
FAX 209/466-0260



© 2008 Western Marine Insurance Services Inc.