< BACK TO RISKS  | PRINT THIS FORM
Application for Non-Owned Aircraft Liability and
Aircraft Damage Liability

This application is for personal renters and flight instructors.
I desire insurance to cover my activities as a (select one):
Personal Renter
This application is for your personal and business related use of non-owned, fixed wing, non-pressurized, land aircraft having a non-turbine single engine of 450 horsepower or less (including non-powered sailplanes) and a capacity of no more than seven (7) total passengers and/or seats and having a standard airworthiness certificate.
Flight Instructor
This application is for your personal, business related flying, and your flight instruction to others in non-owned fixed wing, non-pressurized, land aircraft having a non-turbine single engine of 450 horsepower or less (including non-powered sailplanes) and a capacity of no more than seven (7) total passengers and/or seats and having a standard airworthiness certificate.

Pilot Information:
Your Name:
(Individual only)
Address:
City:
State:
Zip:
Phone:
Email:
  This coverage is not available to
residents of Alaska or Hawaii
Your Occupation:
Age:
Your Pilot Certification: Student
Recreational
Private
Commercial
ATP
Your Ratings:
Instrument:
Total logged hours:
Last 12 months:
What type of aircraft do you usually fly?
Yours hours as PIC in type:
Do you have a CFI-Inst? Yes No
CFI-ME:
Hours of flight instructing:
Flight instruction given in the last 12 months: Yes No
Flight school you rent aircraft from:

Liability Coverage:
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 non-owned aircraft.

Renters:
Each Occurrence Passengers Premium
$ 250,000 $ 25,000 $125
$ 500,000 $ 50,000 $160
$ 500,000 $100,000 $230
$1,000,000 $100,000 $325

Add my Employer as Additional Insured $50
Name of Employer:
Add the Civil Air Patrol Endorsement* $50
**This coverage may be purchased to protect you against claims arising from your participation in Civil Air Patrol Activities. Contact your broker for more information.

Flight Instructor:
Each Occurrence Passengers Premium
$ 250,000 $ 25,000 $200
$ 500,000 $ 50,000 $350
$ 500,000 $100,000 $500
$1,000,000 $100,000 $650

Add my Employer as Additional Insured $50
Name of Employer:

Within the last 36 months have you:
Been involved in any aircraft accident/incident? Yes No
Been cited for any FAR violations? Yes No
Had your pilots or drivers license suspended? Yes No
Been convicted of any felony or DUI charge? Yes No

If you answered “yes” to any of the above,
please contact Bramar Associates

Coverages:

Physical Damage to Your Non-owned Aircraft:
Pays for physical damage to non-owned aircraft for which
you are legally liable.
Physical Damage Limit Premium
$5,000 $125
$10,000 $175
$20,000 $250
$40,000 $450
$60,000 $600
$80,000 $775
$100,000 $975
$150,000 $1,425

*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.

Terrorism Risk Insurance Coverage (TRIA):
Add TRIA coverage $50: Yes No
Add TRIA coverage $25: Yes No
*If only purchasing liability coverage
Decline TRIA coverage: Yes No

< BACK TO RISKS