Aviation Insurance Quote Aircraft Insurance

Aircraft Insurance Quote

This form is used for a single aircraft quotation. It can be used for both pleasure & business (non-commercial) quotations as well as other special or commercial uses (such as Rental and Flight Instruction, Part 135 Charter Operations, Part 91 Sightseeing For Hire, Aerial Photography to name a few).

Owner Information

Last Name
First Name
AOPA Membership #
EAA Membership #
Occupation
Street
City
State
Zip Code
Day Phone
Home Phone
Fax
Email
Current Insurance Company
Expires Month/Day/Year
One Owner
More then one Owner

Co-owner Information

Last Name
First Name
AOPAC Membership #
EAA Membership #
Occupation

Insurance Coverages

$500,000 Combined Single Limit with $100,000 per passenger
$1,000,000 Combined Single Limit with $100,000 per passenger
$1,000,000 Combined with no per passenger limitation
Over Million Combined Single Limit with no passenger limitation

Over Million Combined Single Limit with no passenger limitation

Medical Coverage Each Passenger

$1,000
$3,000
$5,000
$10,000

Aircraft Information

Aircraft FAA #
Make
Model
Year
Value
Airport Base
Airport ID
Aircraft is Hangared
Aircraft is Tied
Aircraft Use:
Pleasure & Business (no commercial operations where a charge is made)
Specialty or Commercial uses
List Specialty or Commercial uses

Pilot

Name
Age
License
Ratings
Total Flight Time
Hours in Model
Hours in Retractable Gear
Hours in Multi-Engine
Hours in Tailwheel
Hours in Rotorwing
If this quote request is for an aircraft which is either Pressurized, Cabin Class, Turbo-Prop, Jet, or Rotorwing please provide the Name and Date of completion of the last Formal Initial or Recurrent Training School (for this make & model aircraft) for each pilot listed above.
Name of School
Date of Completion
Pilot listed above has a valid and effective pilot certificate and has had no aviation accidents, incidents of certificate suspensions, DUI or DWI's unless noted here:
Other Notes
Add Second Pilot No
Yes

Second Pilot

Name
Age
License
Ratings
Total Flight Time
Hours in Model
Hours in Retractable Gear
Hours in Multi-Engine
Hours in Tailwheel
Hours in Rotorwing
If this quote request is for an aircraft which is either Pressurized, Cabin Class, Turbo-Prop, Jet, or Rotorwing please provide the Name and Date of completion of the last Formal Initial or Recurrent Training School (for this make & model aircraft) for each pilot listed above.
Name of School
Date of Completion
Pilot listed above has a valid and effective pilot certificate and has had no aviation accidents, incidents of certificate suspensions, DUI or DWI's unless noted here:
Other Notes
Add Third Pilot No
Yes

Third Pilot

Name
Age
License
Ratings
Total Flight Time
Hours in Model
Hours in Retractable Gear
Hours in Multi-Engine
Hours in Tailwheel
Hours in Rotorwing
If this quote request is for an aircraft which is either Pressurized, Cabin Class, Turbo-Prop, Jet, or Rotorwing please provide the Name and Date of completion of the last Formal Initial or Recurrent Training School (for this make & model aircraft) for each pilot listed above.
Name of School
Date of Completion
Pilot listed above has a valid and effective pilot certificate and has had no aviation accidents, incidents of certificate suspensions, DUI or DWI's unless noted here:
Other Notes