Aircraft Insurance Application

APPLICANT
AIRCRAFT
FAA Registration
Aircraft
Seating
Make and Horsepower of Engine(s)

HangaredTied Down
NoYes
Use of Aircraft
Pleasure and BusinessPatrol FlightsBanner TowingPhotographyCharter(Part 135)OtherCorporate(Industrial Aid) – Flown by professional pilots employed for this purpose
Other Uses (Explain)
LIABILITY COVERAGE AND LIMITS (If unsure, leave fields blank)
ea, occurrence
ea. passenger
  ea occurrence
AIRCRAFT PHYSICAL DAMAGE COVERAGE
   
   
OWNERSHIP – APPLICANT
YesNo
LOSS HISTORY AND PREVIOUS AVIATION INSURANCE
present insurance company?
   
NoYes
NoYes
PILOT INFORMATION
Total Logged Pilot Hours
Date of Last
Pilot 1

Pilot 2

Pilot 3

Pilot 4

Does any pilot have any convictions, suspensions, or revocations relating to driver’s license or airman’s certificate for FAR violations, use, or possession of controlled substance, or driving while intoxicated?

By signing this application, I hereby agree that all information submitted is true and accurate to the best of my knowledge and no information has been withheld or suppressed.












Click to Print