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Flight Accident Insurance Quote

Step 1 of 2

1. Country of Residence?

Please note:

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

Please continue with the quoting process

Country:

2. Date of Birth?

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

Continue

Step 2 of 2

5. Annual Income? USD $

6. Coverage amount? USD $

*

7. Do you travel other than on commercial airlines?

Yes No

How many hours flown in last 12 months?

Estimated hours flying in the NEXT 12 months?

What Purpose?

Air Craft Information?

Privately Owned
Third Party Charter Service Company

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

8. Who is the Applicant?

Get Quote

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