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.
Your Name (Individual only)
Address Line 2
List your ratings
Total logged hours
(Last 12 months)
What type of aircraft do you usually fly?
Your hours as PIC in type
Hours flight instructing
Flight instruction given last 12 months
Within the last 36 months have you:
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.
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 (Choose One of the Following)
Flight Instructors (Choose One of the Following)
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.
Name of Employer (only if you added employer as an additional insured)
* 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
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.
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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