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Personal, Pleasure and Competition Glider Insurance Needs.
Date

Policyholder's Name

Address

Name of Person to Contact

Are you a member of the Soaring Society of America?
YesNo

If yes, please provide your SSA membership #

Occupation/Nature of business

Are you a member of the Aircraft Owners and Pilots Association (AOPA)
YesNo

If yes, please provide your AOPA membership#

Are you just purchasing this aircraft?
YesNo

Present Insurance Company (not agent)

Policy expiration date

Aircraft Schedule

Pilot 1

Glider Certificates/Ratings (i.e Student, Private, Commerical, CFIG)

Total Glider Flights

Total flights in glider with a glide ratio of 35-1 or better

Total Flights in each Make & Model to be Insured

Any physical disabilities that might impact the pilots ability to operate the glider?
YesNo

If yes, please describe:

Pilot 2

Glider Certificates/Ratings (i.e Student, Private, Commerical, CFIG)

Total Glider Flights

Total flights in glider with a glide ratio of 35-1 or better

Total Flights in each Make & Model to be Insured

Any physical disabilities that might impact the pilots ability to operate the glider?
YesNo

If yes, please describe:

Pilot 3

Glider Certificates/Ratings (i.e Student, Private, Commerical, CFIG)

Total Glider Flights

Total flights in glider with a glide ratio of 35-1 or better

Total Flights in each Make & Model to be Insured

Any physical disabilities that might impact the pilots ability to operate the glider?
YesNo

If yes, please describe:

Comments
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