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Insurance for Aviators

AIRCRAFT LIABILITY (including passengers).

AIRCRAFT PHYSICAL DAMAGE INSURANCE options for the aircraft *up to five named Pilots on each policy

a) Flight, Taxi, Trailer, and Ground
b) Ground Only

INSURANCE COVERAGE:

a) Physical Damage (hull)

b) Property Damage

c) Liability
d) Injury to Passengers

e) Accidental Death

If you have any questions, contact Jim Stewart at Falcon Insurance Agency, Inc. at 1-866-647-4322.

Personal Information

EAA Member Number *

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First Name *
Middle Name
Last Name *

Named Insured *

Billing Street Address *
Billing City *
Billing State *
Billing Postal Code *

Email *

Cell Phone *

Work Phone *

Are You a Pilot? (yes/no) *

Pilots License Number

Pilot Certificate

Ratings *

Have you had any of the following in the last 5 years? ( *

Additional information

*Additional information regarding convictions, surrender, revocation,  accidents, incidents, claims, citations, violations, or suspensions

Flight Hours *

Flight Hours last 12 months *

Aircraft Information

Aircraft Make: SkyRunner *

Aircraft Model: MK 3.2 *

Total Seats: 2 *

Gear Configuration: Quad *

Aircraft Use *

Aircraft Year *

Engine Make *

Engine Power *

Coverage Requested

Aircraft Hull Insurance *

Aircraft Hull Value *

The hull value includes instruments, chassis, radios, autopilots, wings, engines, and other equipment attached to or carried on the plane as described in the policy

Last BFR (biennial flight review) Date *

Do you have a current medical? (yes/no) *

Medical Date?

Insurance Information Request

Limits of Liability Insurance *

Medical Payments Insurance *

Quote For *

Current Insurer

Current Policy Expires

Lien Holder

Will there be a lien on the aircraft? (yes/no) *

Aircraft Location

Aircraft Location?

If Other, where will the aircraft be stored?

Airport Name

Airport Identifier

Runway Surface

Runway Length (feet)

Elevation (feet)

If you have any questions, contact one of the aviation insurance professionals with EAA Insurance Solutions administered by Falcon Insurance Agency, Inc. at 1-866-647-4322.