The Aircraft and Owner or Lessor (Named Insured/Registered Owner(s), primary contact/decision maker, address, phone numbers, email address)
About the aircraft owner(s): (In order for us to negotiate the proper terms for all parties concerned, please give brief details about all the principles, partners, members who will be using the aircraft. What is their principle business?)
Aircraft tail number or serial number, year, make & model, and number of total seats- pilot and passenger:
Single or Two Pilot Operation?
single
two pilot
Where is the aircraft based? (tied down or hangered)
Insured (Hull) Value: (The value you want the aircraft to be insured for):
Desired Deductible (We will report the standard deductible offered by each company. Other options can be negotiated after discussion of initial terms with you)
Hull coverage choices:
Ffull flight
Ground (rotors not in motion)
Liability only
Liability Limits: (i.e: $1,000,000/$100,000; $100,000,000 Combined Single Limit) (As a standard practice for small aircraft, the minimum liability we will ask for is $1,000,000 limited to 100,000 per passenger bodily injury. For Industrial aid or commercial uses, higher limits of up to $500,000,000 may be available depending on your aircraft, operation, and use).
Purpose of Use: (What is the aircraft to be used for? Pleasure & Business-owner flown, Industrial Aide-flown by professional pilot, commercial uses such as charter, Instruction & Rental, etc.)
Who will have care, custody, and control of the aircraft? (Is this aircraft being managed by the owner/employees or a management/charter company?)
How many hours a year do you expect to fly the aircraft?
What are the average number of passengers on a typical flight?
Insured Territory: (Where will aircraft usually be flown?
Is there a lien holder? Is a breach of warranty needed?
The Pilots (as a minimum please provide the below information for each pilot. For the best results please provide a pilot history questionnaire found in the Pilot Portal for each pilot in lieu of the below.)
The pilots: name, age, occupation, independent contractor or employee pilot:
FAA ratings (Student, Private, Commercial, ATP, CFI, CFII, MEI/Instrument/ ASEL/ AMEL/RW):
Flight Times:
Total time all aircraft:
Total time in make and model to be quoted:
Total time single engine (ASEL):
Total time multi-engine (AMEL):
Total time rotor wing (RW):
Total time complex/high performance aircraft:
Total time last 12 months:
Date and type of last medical:
Any losses, waivers, or violations within the last 5 years:
Training: (date and type of last training event in make and model and any other significant training. Initial or Recurrent; Simulator or Aircraft based training)
Second Pilot
The pilots: name, age, occupation, independent contractor or employee pilot:
FAA ratings (Student, Private, Commercial, ATP, CFI, CFII, MEI/Instrument/ ASEL/ AMEL/RW):
Flight Times:
Total time all aircraft:
Total time in make and model to be quoted:
Total time single engine (ASEL):
Total time multi-engine (AMEL):
Total time rotor wing (RW):
Total time complex/high performance aircraft:
Total time last 12 months:
Date and type of last medical:
Any losses, waivers, or violations within the last 5 years:
Training: (date and type of last training event in make and model and any other significant training. Initial or Recurrent; Simulator or Aircraft based training)
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