Renewal Update Form

* - denotes required fields

Information
Policyholder  *
E-Mail Address  *
Policy Number 
Expiration Date 
Occupation  *
Aircraft  *
Airport Location (ID, city, State)  *
Hangared or Tied?  Hangared Tied 
Engine hours since new or last major overhaul 
Date of Last Aircraft Annual 
Any change in aircraft use  *

Pilot #1
Name *   Age *
Date of Last Medical  *
Date of Last Flight Review  *
Annual Ground/Flight School completed? 
Date: School:
ASF Courses completed in the last 12 months: (check all that apply)
Single Pilot IFR Runway Safety Datalink IFR GPS Thundersorm
FAA Pilot Proficiency Award Program
Certificates and Ratings held (check all that apply)*
PVTCMLATPCFICFIIMEIRW
INSTMELA&PIASportGlider
Total Hours  *
Multi Engine Hours 
ReTRacTABLE Gear Hours 
Conventional Gear Hours 
Float Plane Hours 
Rotor Wing Hours 
Make and Model Hours  *
Total Time Last 12 Months  *
Total Time Last 90 Days  *
Pilot #2
Name    Age 
Date of Last Medical 
Date of Last Flight Review 
Annual Ground/Flight School completed? 
Date: School:
ASF Courses completed in the last 12 months: (check all that apply)
Single Pilot IFR Runway Safety Datalink IFR GPS Thundersorm
FAA Pilot Proficiency Award Program
Certificates and Ratings held (check all that apply)*
PVT CML ATP CFI CFII MEI RW
INST MEL A&P IA Sport Glider
Total Hours 
Multi Engine Hours 
ReTRacTABLE Gear Hours 
Conventional Gear Hours 
Float Plane Hours 
Rotor Wing Hours 
Make and Model Hours 
Total Time Last 12 Months 
Total Time Last 90 Days 

During the last 12 months have any of the above pilots: Please explain all 'yes' answers below
Had any accident or citation for FAR Violations?  *
Had any license limitations or waivers?  *
Had any felony convictions or license suspensions arising out of the operation of a motor vehicle?  *
Had any arrests for reckless operation of a motor vehicle or while being under the influence of alcohol or drugs?  *
Claim Info (Date of loss, named insured of loss, aircraft type, claim pay-out, carrier that paid claim, description) 

Liability Information
Please quote same Liability Limits as expiring 
Please quote as follows 

Hull Coverage
Amount of Hull Coverage desired upon renewal:  *
Amount of mortgage on above referenced aircraft: 
Any equipment added in the past 12 months (if YES please describe) 
Is aircraft equipped with TAA equipment (IFR approved GPS with moving map & 2-axis autopilot, TCAS)? 

Please Advise if you will require any of the following on your renewal policy:
Lienholder?  Yes No 
Mexican Liability Certificate?  Yes No 
Canadian Liability Certificate?  Yes No 
Airport or Hangar Owner as Additional Insured?  Yes No 
Additional Insured 1
Name: 
Address: 
City: 
State: 
Zipcode: 
Additional Insured 2
Name: 
Address: 
City: 
State: 
Zipcode: 
Lienholder
Name: 
Address: 
City: 
State: 
Zipcode: 

AOPA Membership #:

EAA Membership #:
Remarks: 
ElecTRonic Signature of Applicant or Authorized Representative:  *
Date:  *
Best Phone:  *
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