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Request to
collect
LifeLine Benefits
Use this screen to apply
for LifeLine Emergency Expense Reimbursement benefits
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Please provide as much
information as possible to avoid processing delays |
| Your name |
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| Telephone
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| Fax
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| Email
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| Is the boat insured in your name?
If not tell us the name of our contract holder if different |
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| LifeLine Contract number (if known) |
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Information about your boat |
| Boat's name |
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| Year, Builder (Make) and model |
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| (e.g. 1995 Hunter PassageMaker sloop) |
| Length |
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Information about the loss |
| Date and time |
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| If this is a Named Storm
(Hurricane) event please indicate Storm Name (e.g.
George, Charley, Frances, etc.) |
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| Where did the
event occur?
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Be specific.
"The Bahamas" is too general. "Hatchet Bay, Eleuthera,
Bahamas" tells us a lot more. |
| Describe what
happened |
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Try to recall as much
detail as possible if you were there. If you were not there tell us what you
know. |
| Describe the damage to your vessel.
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This is to give us an idea
of the extent of the claim, e.g. Is it a scratch or a total loss. |
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Who was operating the vessel at the
time of the event? |
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If
not under command state "Not under command" |
| Who was injured? |
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State their name, gender,
age if known and relationship to you. If no injuries
state "None" |
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Thank you for your assistance in completing this
report. Before clicking the SUBMIT button, please review your replies
for accuracy and completeness.
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Click SUBMIT only ONE TIME ▼ |
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If you are able, print
this report now before submitting. This will give you a written copy.
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This information is the
preliminary information used to open a file, contact you and review your
request. |
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The easier it is to
contact you and locate you, the quicker you will see results. |
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Click SUBMIT only ONCE►►
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