OFM, Risk Management Division - Marine Policy Form

MARINE POLICY CHANGE REQUEST

Instruction: For add or delete Marine Policy of vessels over 26' long with 50HP motor or more. Once the form is submitted, it will send the information you enter to RMD for processing. If you have any questions or problems, please contact RMD customer services at 360.902.7303.

Fields in Blue are required on both ADD and DELETE request types
Fields in Green are required on ADD only
Fields in Brown are optional

Request type:
ADD       DELETE

Agency Information:

Agency:

Effective Date:

Requestor:

Phone:

Email:

Vessel Information:

Name:

Year:

Make: Model:

Length: (feet)       Horse Power:

# of crew:    #of passenger seats:

Value of Vessel:$

Deductible:

Hull:
P&I:
$
$

Use & Trip Information:

Purpose & Use:

Radius of Operation:

Comments/Additional Information:

	Request type: ADD DELETE
Agency Information:
Agency:
Effective Date:
Requestor:
Phone:
Email:
Vessel Information:
Name:
Year:
Make:	Model:
Length:	(feet) Horse Power:
# of crew:	#of passenger seats:
Value of Vessel:$
Deductible:	Hull: P&I:	$ $
Use & Trip Information:
Purpose & Use:
Radius of Operation:
Comments/Additional Information: