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Aircraft Insurance

About Our
Seaplane Insurance

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Seaplane FAQ

 

Aircraft Insurance Questionnaire

Name
Address
City
State Zip Code
Phone ( )
Fax ( )
E-mail
Name of Registered Owner
Prior Insurance Co.
Aircraft Make
  Model
  Year
  Reg. #
  # of Seats
  Liability Limit
Value Hull $
 

Floats & Skis

 $
  Float type



Amphibian Aircraft

  Land Planes



  Seaplanes

Moored
Location of Aircraft
Dates Aircraft is on floats From / through /
When not on floats the aircraft will be
In storage
 
NAMED PILOTS
  Pilot 1 Name
  Date of Birth
  License and Ratings
  Total Logged Hrs. - All Aircraft
  Total Logged Seaplane Hrs. - This Aircraft
  Total Logged Seaplane Hrs.
  Total Logged Hrs. - This Aircraft
  Multi Engine Hours
  Turbine Hours
  Tailwheel Hours
  Retract Hours
  Hours Past 12 Mo.
  Medical Date
  BFR Date
  Have you received recurrent training in your aircraft on floats
or wheels in the past 12 months?
    Yes No
  If yes, please explain
     
  Pilot 2 Name
  Date of Birth
  License and Ratings
  Total Logged Hrs. - All Aircraft
  Total Logged Seaplane Hrs. - This Aircraft
  Total Logged Seaplane Hrs.
  Total Logged Hrs. - This Aircraft
  Multi Engine Hours
  Turbine Hours
  Tailwheel Hours
  Retract Hours
  Hours Past 12 Mo.
  Medical Date
  BFR Date
     
  Have you received recurrent training in your aircraft on floats
or wheels in the past 12 months?
    Yes No
  If yes, please explain
     
  Pilot 3 Name
  Date of Birth
  License and Ratings
  Total Logged Hrs. - All Aircraft
  Total Logged Seaplane Hrs. - This Aircraft
  Total Logged Seaplane Hrs.
  Total Logged Hrs. - This Aircraft
  Multi Engine Hours
  Turbine Hours
  Tailwheel Hours
  Retract Hours
  Hours Past 12 Mo.
  Medical Date
  BFR Date
     
  Have you received recurrent training in your aircraft on floats
or wheels in the past 12 months?
    Yes No
  If yes, please explain
     
  Pilot 4 Name
  Date of Birth
  License and Ratings
  Total Logged Hrs. - All Aircraft
  Total Logged Seaplane Hrs. - This Aircraft
  Total Logged Seaplane Hrs.
  Total Logged Hrs. - This Aircraft
  Multi Engine Hours
  Turbine Hours
  Tailwheel Hours
  Retract Hours
  Hours Past 12 Mo.
  Medical Date
  BFR Date
     
  Have you received recurrent training in your aircraft on floats
or wheels in the past 12 months?
    Yes No
  If yes, please explain
 
Any losses, accidents, revocations, suspensions, etc?
 

Yes No
If Yes, explain

 

Any waivers on Medical? Yes No
If Yes, explain

 

Any lien on aircraft? Yes No
Amount $
Comments
   
Signed: ________________________________________________
Date

For more information follow the links above
or call 1-800-737-7873

 
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