If you would like us to contact you please complete the form below. This information is for internal use only; none of the following will be distributed to any other parties. See our privacy statement for more information.

* Indicates a required field

This application is for personal renters and flight instructors. I desire insurance to cover my activities as a (select one):
Personal Renter -- This application is for your personal, business- related use of non-owned, fixed wing, non-pressurized, land aircraft having a non-turbine single engine of 450 horsepower or less (including nonpowered sailplanes) and a capacity of no more than seven (7) total passengers and/or seats and having a standard airworthiness certificate.
Flight Instructor -- This application is for your personal, business-related flying, and your flight instruction to others in non-owned, fixed wing, non-pressurized, land aircraft having a non-turbine single engine of 450 horsepower or less (including non-powered sailplanes) and a capacity of no more than seven (7) total passengers and/or seats and having a standard airworthiness certificate.
 
  
PILOT INFORMATION
 
*Your Name (Individual only)
 
*Please provide Email Address or Telephone:
Email Address
Telephone
 
Address
*City
*State
(This coverage is not available to
residents of Alaska or Hawaii)
*Zip
Your Occupation
Your age
AOPA Number
Your Pilot Cert.
 Student Rec. Pvt.
Cmcl. ATP
Your Ratings: Inst.
Other Ratings
Total logged hours
(Last 12 months)
What type of aircraft do you usually fly
Your hours as PIC in type
Do you have a
 CFI -- Inst. CFI-ME
Hours flight instructing
Flight instruction given last 12 months
 
Within the last 36 months have you:  
Been involved in any aircraft
accident/incident?		 Yes No
Been cited for any FAR violation? Yes No
Had your pilot or driver's license
suspended?		 Yes No
Been convicted of any felony or
DUI charge?		 Yes No
If you answered "yes" to any of the above, please contact us at 1-800-826-4442.
 
Coverage underwritten by AIG AVIATION INC.

For more information about multi-engine and helicopter coverage, please call toll free 1-800-826-4442.
 
COVERAGES

Liability Coverage
Pays for bodily injury and property damage for which you are legally liable arising out of your use of non-owned aircraft, but excluding physical damage to nonowned aircraft.
Personal Renter
Each
Occurrence		 Passengers Non-AOPA
Premium		   AOPA
Premium 		 
$250,000   $25,000   $85 $80
$500,000   $50,000   $114 $108
$500,000   $100,000   $180 $171
$1,000,000   $100,000   $219 $208
 
  
Flight Instructors
Each
Occurrence		 Passengers Non-AOPA
Premium		   AOPA
Premium 		 
$250,000   $25,000   $200 $190
$500,000   $50,000   $350 $332
$500,000   $100,000   $500 $475
$1,000,000   $100,000   $650 $617
 
Physical Damage to Your Non-owned Aircraft
Pays for physical damage to non-owned aircraft for which you are legally liable. This coverage is only available in conjunction with Liability coverage.
Physical Damage Limit   Non-AOPA
Premium		   AOPA
Premium 		 
$5,000     $99   $94  
$10,000     $175   $166  
$20,000     $250   $237  
$30,000     $350   $332  
$40,000     $450   $427  
$60,000     $600   $570  
$80,000     $775   $736  
$100,000     $975   $926  
$150,000     $1425   $1353  
$200,000     $1900   $1805  
Decline Physical Damage coverage
 
Optional Coverage
+Add my employer as an
additional insured ($50)
Name of employer
++Add the Civil Air Patrol endorsement ($50)
 
+ Your employer may require this coverage if you use non-owned aircraft on company business. This coverage is not available to Student or Recreational pilots. Coverage does not apply to employers who are: involved in the manufacture, building, designing, selling, or distribution of aircraft, aircraft engines, parts, accessories, components, or fuel; engaged in the operation of an aircraft repair shop, sales agency, rental service, flight school, pilot training center or any other commercial flying service.

++ This coverage may be purchased to protect you against claims arising from your participation in Civil Air Patrol activities. Contact your broker for more information.
 
Coverage for Acts of Terrorism under the Terrorism Risk Insurance Act of 2002

Pays for bodily injury and property damage for which you are legally liable from certified acts of terrorism.
Required : TRIA coverage ($1)
I would like to begin one year of
coverage on
I understand that coverage shall not be effective until the company has accepted my application and premium payment has been received in full by Professional Insurance Management, Inc. I also understand that my actual policy will have terms and conditions not found in this general description. I warrant that all of the information in this application is true and complete to the best of my knowledge.
 
 
Some states require that we notify you that any person who knowingly and with intent to defraud any insurer, or other person, files an insurance application containing false or misleading information or any fact material thereto, commits a fraudulent insurance act which is a crime.

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