Commercial & Business Aircraft Application

If you would like to request an online quote 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.

   
*Owner's Name:  
Street Address:  
*City:  
*Province:  
Postal Code:  
*Please provide Email Address or Day Phone:
Email Address:  
Day Phone:  
Fax:  
   
Present Insurance Company
Underwriter:
Expiration Date:

Describe your Aircraft
Registration letters:  
Year:  
Make:  
Model:  
Insured Value:  
Total Seating [ ] Crew + [ ] Passengers:  
Land     Sea     Amphib

Where is your Aircraft Based?

Airport:
City/Province:
Airport ID:
Hangared     Tied Down

Aircraft Use

Pleasure & Business
Industrial Aid (Pro-flown)

Other:
   
Lien Information:
Lien Holder:  
Lien Amount:  

Limits of Liability (Indicate Quote Requests)

$1,000,000 Each Occurrence - $300,000 Each Passenger  
$1,000,000 Each Occurrence - No Passenger Limitation  
$5,000,000 Each Occurrence  
$10,000,000 Each Occurrence  
Other (i.e. $20,000,000, $200,000,000, etc.):

Territory required:

Canada only   
Canada and continental USA (excluding Alaska)  
   
Pilot Name:  
Occupation:  
Date of Birth:   / /
Type of License:   Student  PVT  COML  ATP    Additional Ratings:   IFR    ME
Total Hours Retract Gear Multi Engine Tail Wheel Turbine Last 12Months In this Model
   
Pilot Name:  
Occupation:  
Date of Birth:   / /
Type of License:   Student  PVT  COML  ATP    Additional Ratings:   IFR    ME
Total Hours Retract Gear Multi Engine Tail Wheel Turbine Last 12Months In this Model
   
Pilot Name:  
Occupation:  
Date of Birth:   / /
Type of License:   Student  PVT  COML  ATP    Additional Ratings:   IFR    ME
Total Hours Retract Gear Multi Engine Tail Wheel Turbine Last 12Months In this Model
   
Pilot Name:  
Occupation:  
Date of Birth:   / /
Type of License:   Student  PVT  COML  ATP    Additional Ratings:   IFR    ME
Total Hours Retract Gear Multi Engine Tail Wheel Turbine Last 12Months In this Model
   
Annual Proficiency Training Yes No

If Yes, please describe Training:

Date of Training: / /

Average Passenger Load:

Percentage employees vs. guests:

Average route or trip radius:

History/ Miscellaneous
Give particulars of accidents, claims and/or certificate suspensions of pilots over last five years:

Please let us know how you heard about us:

    Other:


If this form is being filled out by a broker, please fill out the following information.

Name of Brokerage:

Contact:

Phone #:

Email address: