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INSURANCE APPLICATION

Your Information

LIABILITY LIMITS
HULL COVERAGE
TOTAL PREMIUM
DESCRIPTION OF AIRCRAFT
Aircraft #1
Aircraft #2
Purpose Of Use

PLEASURE & BUSINESS
The term “Pleasure and Business” is defined as Personal and Pleasure use and use in direct connection with the insured’s business, excluding any operation for which a charge is made.

INDUSTRIAL AID
The term “Industrial Aid” is defined as including the uses enumerated in the definition of “Pleasure and Business” and also includes the transportation of executives, employees, guests, and customers, excluding any operation for which a charge is made.

LIMITED COMMERCIAL
The term “Limited Commercial” is defined as including the uses in (A) and (B) above and including Student Instruction and Rental to pilots but excluding passenger carrying for hire or reward.

COMMERCIAL EX INDUSTRIAL OR RENTAL
The term “Commercial Ex Instruction or Rental” is defined as including all of the uses under (A) and (B) above and use of the aircraft for the transportation of passengers and/or freight for hire but excluding any use of the aircraft for instruction or rental to others.

COMMERCIAL
The term “Commercial” is defined as including all the uses permitted under (C) and (D) above.

FLYING CLUB
The term “Flying Club” is defined as including all the uses permitted in (A) above

SPECIAL USE
Please explain / define the special use:

1st Pilot Information

(YES - ) (NO - )—Any physical impairment on Pilot Certificate

(YES - ) (NO - )—Previous Claims

(YES - ) (NO - )—Previous Violations

(YES - ) (NO - )—Previous Accidents

(YES - ) (NO - )—Previous insurance canceled or declined

(YES - ) (NO - )—DUI or DWI

2nd Pilot Information (if applicable)

(YES - ) (NO - )—Any physical impairment on Pilot Certificate

(YES - ) (NO - )—Previous Claims

(YES - ) (NO - )—Previous Violations

(YES - ) (NO - )—Previous Accidents

(YES - ) (NO - )—Previous insurance canceled or declined

(YES - ) (NO - )—DUI or DWI

Notes

(YES - ) (NO - )—IFR Certified GPS w/moving map display?

(YES - ) (NO - )—Auto Pilot with altitude hold?

Other Notes and Information:

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