Aircraft Products Liability Insurance Quote

Aviation Products Liability Insurance Quote

Insured Information

Named Insured

Insured is a

CorporationIndividual(s)Partnership

Name of Business of Named Insured

Contact Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Telephone

Area CodePhone Number

Cell Phone

Area CodePhone Number

Fax

Area CodePhone Number

E-mail

Aircraft Products Sales Information

Estimated Sales Previous 12 Months

Non-Military Aircraft Products

Fixed Wing-Piston Aircraft

Fixed Wing-Turbine Aircraft

Helicopter

Other

Total

Estimated Sales Next 12 Months

Non-Military Aircraft Products

Fixed Wing-Piston Aircraft

Fixed Wing-Turbine Aircraft

Helicopter

Other

Total

Estimated Sales Previous 12 Months

Military Aircraft Products

Missiles & Spacecraft - exclude Space Shuttle

Helicopter

Space Shuttle

All Others

Total

Estimated Sales Next 12 Months

Military Aircraft Products

Missiles & Spacecraft - exclude Space Shuttle

Helicopter

Space Shuttle

All Others

Total

Policy Period

Effective Date

MonthDayYear

Liability Limits

Products (BI) & (PD) (Aggregate)

Grounding (Aggregate)

Other Information

Describe the aircraft products manufactured or sold by the Named Insured or its subsidiaries. Submit brochures or other similar material (if available), and specify the AIRCRAFT AND AIRCRAFT SYSTEMS in which products are used

How many years have you operated under your present business name?

Describe the terms of any basic or extended warranties provided for the aircraft products that you manufacture. Submit samples copiers if available.

Names of key customers to whom your aircraft products are sold

Describe the testing and engineering controls used to maintain quality control of aircraft products

Do you manufacture the entire product?

YesNo

If no, describe the component part(s) source from others

Do you fully assemble the product?

YesNo

If no, describe assembly services sourced from others

Do you maintain and/or service your products?

YesNo

If yes, attach full details including copy of your standard written service contract and receipts from this source

Upload a File

Are any of your aircraft products flammable, explosive, toxic or otherwise hazardous?

YesNo

If yes, list details

Have you ever been sued or has any claim ever been made against you in connection with any of your aircraft products, whether or not such products are subject of this application?

YesNo

If yes, provide details

Are you aware of any incident, occurrence or circumstance involving any of the products described on this application which is likely to result in a claim against you?

YesNo

If yes, provide details

Have any of your aircraft products ever been subject to any inquiry or investigation by any Government Agency concerning their operation, use, adequacy or labeling, hazardous contents or safety?

YesNo

If yes, set forth full details and results of such inquiry

Have any of your aircraft products ever been withdrawn from the market either voluntarily by you or by order of any Government Agency?

YesNo

If yes, provide full details

Did you discontinue the manufacture of any aircraft product during the past 5 years?

YesNo

If yes, please explain

Are you planning to manufacture or market any new aircraft products during the next 12 months?

YesNo

If yes, provide full details

Have you carried Products Liability Insurance in the past?

YesNo

If yes, provide the insurer name, policy number and limits for coverage carried during the past 12 months

Has any Insurer cancelled, declined or refused to renew your Products Liability Insurance?

YesNo

If yes, provide details

Comments & Questions

Any other comments or questions?