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Flight Accident Insurance Quote
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Please note:


Automatic approval is only available for residents of
Costa Rica, Panama, Ecuador, Colombia, Peru.

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Country:

 
3. Current Occupation?
 

Type your current occupation

Please explain your occupation
4. Do you have any other Accidental Death (AD&D) coverage inforce?
 
Yes      No

Insurance carrier Coverage end date Amount of insurance Type of Insurance
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Step 2 of 2

 
 
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Yes       No



How many hours flown in last 12 months?
Estimated hours flying in the NEXT 12 months?
What Purpose?
Air Craft Information?
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Type of license held
License date of issue
Do you hold a valid instrument rating?
Purpose of current flying
Total hours flown as a pilot/crew member
Total hours flown last 24 months
Total hours expected to fly next 12 months
Date of last flight
What aircraft do you currently fly (full description)
Total hours in aircraft currently flying
Do you expect any change your flying plans or aircraft flown in the next 12 months? (No/ If Yes, Please explain)
Do you engage in any of the following aviation activities (Check all that apply)
Flight transport
Charter
Survey
Sight seeing
Stunt flying
Helicopter
Commercial photography
Flight instructor
Aerobatics
Mapping
Crop dusting
Other:
Medical Certificate
Date of last renewal of certificate
Has your medical certificate ever been denied?
(No/ If Yes, Please explain)
Have you even been in an accident, been fined or grounded for a violation or air relations? (No/ If Yes, Please explain)
Please describe any other additional flying experience not mentioned above
 
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