Light Aircraft Quote Form
Current Policy Information
Policy Type:
*
Individual
LLC
Partnership
Registered Aircraft Owner:
Policy Expiration Date (If unknown or new, leave blank)
-
Month
-
Day
Year
Date Picker Icon
Primary Use
*
Pleasure & Business
Other
If other, please explain.
Primary Named Insured
Name
*
First
Last
Phone Number
*
Email
*
Confirm Email Address
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Occupation
*
Associations
AOPA – Aircraft Owners and Pilots Association
Member ID
EAA – Experimental Aircraft Association
Member ID
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Aircraft Information
N-Number
*
Year
*
Make
*
Model
*
# of Seats
*
Engine Make & Model
*
Aircraft Value
*
e.g., $25000.00
TAA Avionics?
*
Yes
No
Any major modifications, including engine type, that differ from the original design?
*
Yes
No
If yes, please explain
Airport Information
Airport Code
*
Private/Unlisted
Is your aircraft hangared?
Yes
No
Coverage
Please select desired coverage types and levels. Questions About Coverage? Call us at 877-457-5860.
Select Coverages
*
Full Ground/In Flight
Ground & Taxi
Ground not in motion
Liability Only
Please select desired level of coverage (Bodily injury and property damage coverage/injury limit per passenger)
*
$1,000,000/$100,000
$1,000,000/$200,000
$1,000,000/$250,000
$1,000,000/$1,000,000
$2,000,000/$200,000
$2,000,000/$250,000
$2,000,000/$2,000,000
Other Coverage Not Listed*
Do you plan to fly this aircraft outside of the 48 contiguous United States?
*
Yes
No
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Pilot #1 Information
Name
*
First
Last
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Certificate
*
Private
Student
Light Sport Pilot
Commercial
ATP
Ratings
*
Single Engine Land
Instrument
CFI
Multi-Engine
Rotorcraft
Sea
Balloon
Other
Pilot #1 Hours
Fill in all that apply.
Total Hours
*
Last 12 Months
*
Pilot hours in the make/model being insured
*
Retractable
Turbine
Multi-Engine
Tail Wheel
Floats
Rotor Wing
Light Sport Aircraft
If other, please explain
Pilot #1 Training
Last Biennial Flight Review
*
Last Instrument Proficiency Check
Last Medical
*
Last Recurrent Training
-
Month
-
Day
Year
Date Picker Icon
Describe Training
*
Pilot #1 History
Has any insurer ever cancelled or non renewed any aviation insurance policy or coverage for this pilot?
*
Yes
No
If Yes, Please provide details
Any incidents or accidents within the last 5 years?
*
Yes
No
If Yes, Please provide details
Any license limitations, certificate suspensions/revocations, or citations for FAR violations within the last 5 years?
*
Yes
No
If Yes, Please provide details
Any physical impairments or limitations or waivers on the Medical Certificate (other than vision)?
*
Yes
No
If Yes, Please provide details
Any arrests or convictions for operation of a motor vehicle or aircraft recklessly, and/or under the influence of alcohol or drugs?
*
Yes
No
If Yes, Please provide details
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Pilot #2 Information
If insuring a second pilot, please complete all applicable fields below. If only insuring only one pilot, please proceed to bottom of quote form and submit.
Name
First
Last
Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Certificate
Private
Student
Light Sport Pilot
Commercial
ATP
Ratings
CFI
Instrument
Multi-Engine
Rotorcraft
Sea
Balloon
Other
If other, please explain
Pilot #2 Hours
Fill in all that apply.
Total Hours
Last 12 Months
Pilot hours in the make/model being insured
Retractable
Turbine
Multi-Engine
Tail Wheel
Floats
Rotor Wing
Light Sport Aircraft
If other, please explain
Pilot #2 Training
Last Biennial Flight Review
Last Instrument Proficiency Check
Last Medical
Last Recurrent Training
-
Month
-
Day
Year
Date Picker Icon
Describe Training
Pilot #2 History
Has any insurer ever cancelled or non renewed any aviation insurance policy or coverage for this pilot?
Yes
No
Any incidents or accidents within the last 5 years?
Yes
No
Any license limitations, certificate suspensions/revocations, or citations for FAR violations within the last 5 years?
Yes
No
Any physical impairments or limitations or waivers on the Medical Certificate (other than vision)?
Yes
No
Any arrests or convictions for operation of a motor vehicle or aircraft recklessly, and/or under the influence of alcohol or drugs?
*
Yes
No
Need to add additional pilots?
If you need to add another pilot, please Submit this form and then call 1-877-648-8267.
How did you hear about us?
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