1. Pilot
2. Finish Line


Name of Aircraft Owner/Company
Tail #
Pilot Name
Pilot Email
Pilot Phone
Pilot Age
Certificate
Rated
Other Ratings
Total Hours All Aircraft
Total Hours Retract
Total Hours Multi Engine
Total Hours Tailwheel
Total Hours last 12 months
Hours in Make/Model
Hours in Make/Model Last 12 Months
Medical
Medical Date
Last BFR
Last IPC
1. Pilot
2. Finish Line


Have you or any of the pilots had any Aviation losses, accidents, violations, FAA waivers, DUI, Felony or Fraud convictions?
If yes, please provide details:
Will the aircraft be used for any operations for hire, for a charge, or in Waivered airspace?
If yes, please provide details:
Additional Comments
FRAUD WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
By submitting this application you have read and understand the Fraud Warning.