Turboprops

Private & Corporate Jets

Airliners

  
Turbo-Prop/Jet Insurance Quote Request

This form is used for a turbine aircraft insurance quotation.  It can be used for Pleasure & Business (non-commercial use including owner flown operations), Industrial Aid (non-commercial use, corporate owned, and pro-pilot crew), Commercial uses such as Part 135 Charter Operations and Type Rating Flight Training.  Please complete this form to receive your insurance quote.

 Owner Information:

Name              Occupation/Business      
Individual     INC     LLC     Partnership     Trust     Municipality

Contact name (if an organization) 

 Address: Street                            City    
                  State                              Zip

         Day Phone      Alternate Phone 

                      Fax                        Email 


Co-owner Information:

Name       Occupation/Business    
Individual     INC      LLC      Partnership     Trust


Insurance Information:

Present Ins. Company        Expires MM/DD/YY 

Has applicant had any losses/claims during last 5 years?    No     Yes*  
Has any insurer canceled, declined or refused to renew any aviation insurance?    No     Yes*  
*If yes, please explain: 
  

Liability Insurance Coverage Limit: 
 $1,000,000 Combined Single Limit* 
 $5,000,000 Combined Single Limit* 
 $10,000,000 Combined Single Limit*  
 $ Combined Single*  
          *There is no per-passenger sub limit

Medical Coverage Each Passenger:  
 $5,000         $10,000       Other:  $


Aircraft Information:

FAA #:     Year:      Make: 

Model:       Insured Value:

Airport Base:   Airport ID:      Hangared

Aircraft Use: 
 Pleasure & Business Only (no commercial operations where a charge is made)  
  Industrial Aid (no commercial operations where a charge is made) 
  Part 135 Charter    Type Rating Training    Other: 

Annual number of hours expected to fly: 

Average Passenger Load: 

Will aircraft be operated outside of the USA or Canada:    No     Yes

If Yes, what countries:  

Aircraft be crewed: 
 Single Pilot     Two Pilot Crew     Both at times   
  % SP        % 2-Pilot


Pilot Information:

Pilot #1:    Pilot In command       Second In Command

Name:          Age: 

Type of License:    Private    Commercial    ATP

Ratings:   Instrument     Single Engine    Multi-Engine    CFI      CFII    Other:  

Typed in the following aircraft:

Total Flight Time:      Hours in Insured Model:  

Retractable Gear hours:      Multi-Engine hours:

Turbo-Prop hours:     Jet hours:  

Name and Date of completion of the last Formal, Initial, or Recurrent Training School for this make & model. 
Name of School:      Date of Completion: 

Pilot listed above has a valid and effective pilot certificate and has had no aviation accidents, incidents or certificate suspensions, DUI or DWI's unless noted here: 
  


Pilot #2:    Pilot In command       Second In Command

Name:          Age: 

Type of License:    Private    Commercial    ATP

Ratings:   Instrument     Single Engine    Multi-Engine    CFI      CFII    Other:  

Typed in the following aircraft:

Total Flight Time:      Hours in Insured Model:  

Retractable Gear hours:      Multi-Engine hours:

Turbo-Prop hours:     Jet hours:  

Name and Date of completion of the last Formal, Initial, or Recurrent Training School for this make & model. 
Name of School:      Date of Completion: 

Pilot listed above has a valid and effective pilot certificate and has had no aviation accidents, incidents or certificate suspensions, DUI or DWI's unless noted here: 
  


Pilot #3:    Pilot In command       Second In Command

Name:          Age: 

Type of License:    Private    Commercial    ATP

Ratings:   Instrument     Single Engine    Multi-Engine    CFI      CFII    Other:  

Typed in the following aircraft:

Total Flight Time:      Hours in Insured Model:  

Retractable Gear hours:      Multi-Engine hours:

Turbo-Prop hours:     Jet hours:  

Name and Date of completion of the last Formal, Initial, or Recurrent Training School for this make & model. 
Name of School:      Date of Completion: 

Pilot listed above has a valid and effective pilot certificate and has had no aviation accidents, incidents or certificate suspensions, DUI or DWI's unless noted here: 
  


Pilot #4:    Pilot In command       Second In Command

Name:          Age: 

Type of License:    Private    Commercial    ATP

Ratings:   Instrument     Single Engine    Multi-Engine    CFI      CFII    Other:  

Typed in the following aircraft:

Total Flight Time:      Hours in Insured Model:  

Retractable Gear hours:      Multi-Engine hours:

Turbo-Prop hours:     Jet hours:  

Name and Date of completion of the last Formal, Initial, or Recurrent Training School for this make & model. 
Name of School:      Date of Completion: 

Pilot listed above has a valid and effective pilot certificate and has had no aviation accidents, incidents or certificate suspensions, DUI or DWI's unless noted here: 
  


Anything else that we need to know: