• Aviation Insurance Application

    Aviation Insurance Application

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  • Applicant Information

  • Operations of Applicant

  • Identify all operations performed and their estimated gross receipts for next 12 months.

  • Receipts from the above categories are for the following types of aircrafts:*

  • Premises

  • Applicant Occupies:*
  • Applicant Is:*
  • Does the Applicant have air shows, contests, or exhibitions on premises?*
  • Runways*
  • Approach Obstructions?*

  • Products & Completed Operations

    Products & Services
  • Are you a member of the Professional Aviation Maintenance Association (PAMA) or SAE International?*

  • Estimated Gross Receipts Next 12 Months for Repair of:

  • Estimated Gross Receipts Next 12 Months for:

  • Does applicant fuel / defuel any aircraft?
  • Has applicant performed any engine or airframe modification work?
  • Has applicant ever sold, serviced or repaired “ultra-light” or “homebuilt” aircraft

  • Hangarkeeper's Liability

    Aircraft in applicant's care, custody or control
  • Does applicant fly customer’s aircraft? *

  • Coverages & Limits Requested

    Please provide the commencement / termination dates for the policy period & the Limits of Insurance for each Coverage applicable.
  • From
     - -
  • Until
     - -

  • Commercial General Liability

  • Hangerkeeper's Liability Coverage

  • Policy Deductible

  • Current Insurance

  • Expiry Date*
     / /

  • Claims/Loss History & FAR Violations

    List all claims and FAR Violations for past 10 years:

  • APPLICANT CERTIFICATION

    The Applicant certifies that the statements in this Application are true and that no material information has been withheld or suppressed. The Applicant agrees that this Application and the terms and conditions of the policy in use by the insurer shall be the basis of any contract between the Applicant and the Insurer. The Applicant hereby authorizes this Company to investigate all or any qualifications or statements contained herein. The Applicant understands that this application does not commit the Company to any liability nor make   the Applicant liable for any premium unless the Company agrees to bind this   insurance.

  • FRAUD WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

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