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Your Pilot Qualifications

To request pilot approval for an existing policy, please complete the Pilot History Form below. This helps us provide you information and/or a quote as quickly as possible. All pilot hours and training must be logged and provable; some underwriters may also require a signed form from the pilot. Please note that no pilot shall be considered approved, and no coverage shall apply, unless you are notified as such in writing from Alexander Aviation or the insurance company.

Pilot History Form

Please complete the following form and review your responses carefully before clicking Submit.

* indicates a required field.

Registered Owner or Named Insured

FAA Number

Make and Model

Aircraft Use

Personal or Business Use (FAR Part 91)

Flight Instruction or Rental (FAR Part 61 / 141)

Air Charter (FAR Part 135)

Aerial Photography / Patrol (FAR Part 91)

Other Use

Pilot's Name

*

Email

Daytime Phone

*

Age

Certificates / Ratings (Check All That Apply)

CFI

CFII

MEI

Total Logged Hours
Sport Pilot Hours
Retractable Gear Hours
Multi-Engine Hours
Tailwheel Hours
Seaplane Hours
Rotorcraft Hours
Turbo-Prop Hours
Jet Hours
Make and Model Hours

FAA Certificate Number

AOPA Membership Number

Are you seeking single-pilot approval for this aircraft?

Yes

No

Have you completed the manufacturer's recurrent training program within the last 12 months?

Yes

No

Training School
Training Date	(mm/yyyy)

Have you logged fewer than 100 flight hours in the preceding 12 months?

Yes

No

Explanation

Have you had any aviation accidents, incidents, violations, aviation insurance claims or automotive DUI convictions within the last 5 years?

Yes

No

Explanation

By submitting this form, I certify that I am authorized to submit underwriting information on behalf of the named insured. I understand that no pilot shall be considered appoved and no coverage shall apply unless I am notified in writing by the insurance company. All listed pilot hours and training certificates are true and correct, logged and provable.

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