Marine Damage Appraisal Request Form

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Please complete the following form to request our Marine Damage Appraisal Services. Please provide as much information as possible. Marine Insurance Services is pleased to offer our Appraisal Services within a 200 km radius of Midland, covering Central Ontario.

Name:

Company:

Address:

City/Town:

Province/State:

Country (Canada or USA):

Postal Code:

Telephone Number:

FAX Number:

E-Mail Address:

Insured Name(s):

Insured Address:

Insured Telephone Number(s):

Policy Number:

Claim Number:

Policy Limits:

Actual Cash Value
Replacement Cost
Valued Policy
Multiple items may be chosen.

Amount of Deductible:

Location of Appraisal:

Phone and Arrange:

Type of Vessel:

Type of Damage/Occurrence:

Identifying Numbers/Name:

Additional Instructions:

Comments and Suggestions:

Marine Appraisal Rates, 1998
SERVICE	APPRAISALS
Hourly Fee	$30.00
Mileage per km	$0.30
Photographs	$2.00/Each
Office Fee (Includes Report)	$10.00
Police, Weather, Fire Department, Other Reports	Cost
Phone/FAX	Phone Rates
Postage/Courier	Cost
Sworn Documents	No Charge
Marine Unit (includes crew and fuel) per hour	$125.00
Marine Surveys (pre-damage) per foot overall length	$10.00

Thank you for using Marine Insurance Services Online Appraisal Services. If you have not received confirmation of receipt of this form within 24 hours, please contact our offices.