ACORD 276 (2009/05)

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 276 (2009/05)
Aircraft Insurance Binder
ACORD 276, Aircraft Insurance Binder, addresses both Personal
Lines and Commercial Lines Aircraft risks.
Before issuing any binder, the following important considerations should be reviewed and
considered carefully:
* A Binder (Cover Note in some states) is a temporary insurance contract which provides
coverage in advance of the issuance of an insurance policy.
* The improper use of binders has become a major cause of producers Errors and
Omissions claims. It is imperative that only authorized people prepare them. Preparation
must be complete and accurate.
* All binders must conform to the state insurance code for the state in which the subject of
insurance in located.
* The maximum and/or minimum term of a binder may be governed by state statute
and/or company underwriting instructions.
* At the end of the binders specified term, all coverage expires unless a new binder has
been issued or the expired binder has been replaced with a policy .
TITLE
* The language in the binder must be precise. Do not use vague or all-encompassing
terms which may imply coverages not intended, such as All Risk. If possible, use the
same language and terminology that will appear on policy.
* An agent may only issue binders which comply with the companys underwriting
instructions (per company manual, agency agreement, correspondence and/or company
underwriter). If the authority is not in writing, the agent should obtain written authority.
Most agency agreements contain stated time frames within which the company must be
notified of any risk bound.
* Generally, a broker cannot bind insurance. A broker may only exercise the authority
extended by the company. It is recommended that individual binders be issued for each
company affording coverage.
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Section Name
Field Name
Field and/or Section Description
TITLE
* Most agency agreements dealing with surplus lines and specialty market contracts do
not allow the agent or broker to bind coverage. Authorization must be secured prior to
binding.
* A binder provides coverage for a specified period. In most jurisdictions, a premium
must be charged for this period unless the binder is replaced by a policy. A deposit should
be obtained when issuing a binder. A deposit premium may be required by some
companies.
* Most companies prohibit issuing or extending binders where coverage has been refused
or cancelled by any carrier.
IDENTIFICATION SECTION Date (MM/DD/YYYY)
Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Agency
Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Contact Name
Enter text: The name of the individual at the producer's establishment that is the primary
contact.
IDENTIFICATION SECTION Phone (A/C, No, Ext)
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
IDENTIFICATION SECTION Fax No. (A/C, No)
Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION Code
Enter code: The identification code assigned to the producer (e.g. agency or brokerage
firm) by the insurer.
IDENTIFICATION SECTION Sub Code
Enter code: The identification code assigned by the insurer to the sub-producer (e.g.
person) within a producer's office (e.g. agency or brokerage).
IDENTIFICATION SECTION Agency Customer Id
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION Name & Mailing Address
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION
Enter text: The named insured's mailing address line one.
IDENTIFICATION SECTION
Enter text: The named insured's mailing address line two.
IDENTIFICATION SECTION
Enter text: The named insured's mailing address city name.
IDENTIFICATION SECTION
Enter code: The named insured's mailing address state or province code.
IDENTIFICATION SECTION
Enter code: The named insured's mailing address postal code.
IDENTIFICATION SECTION Carrier
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
IDENTIFICATION SECTION NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION Binder #
Enter identifier: The number assigned to uniquely identify the binder.
IDENTIFICATION SECTION Effective Date
Enter date: The date on which the terms and conditions of the binder commenced. This
date normally coincides with the effective date of the policy or of an endorsement to the
policy.
IDENTIFICATION SECTION Effective Time
Enter time: The time of the binder effective date that the binder becomes effective.
IDENTIFICATION SECTION Effective Time AM
Check the box (if applicable): Indicates the binder effective time is in the morning (AM).
IDENTIFICATION SECTION Effective Time PM
Check the box (if applicable): Indicates the binder effective time is in the afternoon or
evening (PM).
IDENTIFICATION SECTION Expiration Date
Enter date: The date on which the terms and conditions of the policy will or have expired.
Certain state laws limit the terms of a binder, so this date may not coincide with the policy
expiration date.
IDENTIFICATION SECTION Expiration Time 12:01 AM
Check the box (if applicable): Indicates the binder expires at 12:01 AM on the expiration
date.
IDENTIFICATION SECTION Expiration Time Noon
Check the box (if applicable): Indicates the binder expires at 12:00 noon on the expiration
date.
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION coverage Checkbox
This binder is issued to extend
Check the box (if applicable): Indicates the binder is issued to extend coverage on a policy
where renewal is not yet available.
IDENTIFICATION SECTION Expiring Policy #
Enter identifier: The policy number of the policy that is expiring.
POLICY INFORMATION
Industrial Aid
Check the box (if applicable): Indicates the type of policy is aircraft - industrial aid.
POLICY INFORMATION
Pleasure & Business
Check the box (if applicable): Indicates the type of policy is aircraft - pleasure and
business.
POLICY INFORMATION
Commercial
Check the box (if applicable): Indicates the type of policy is aircraft - commercial.
POLICY INFORMATION
Non-Owned
Check the box (if applicable): Indicates the type of policy is aircraft - non-owned.
POLICY INFORMATION
Other Checkbox
Check the box (if applicable): Indicates the type of policy/perils insured is other than those
listed.
POLICY INFORMATION
Other Description
Enter text: The description of the type of policy issued to the insured.
POLICY INFORMATION
Airplane
Check the box (if applicable): Indicates Airplane is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Helicopter
Check the box (if applicable): Indicates Helicopter is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Mixed Fleet
Check the box (if applicable): Indicates Mixed Fleet is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Excess
Check the box (if applicable): Indicates Excess is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Quota Share
Check the box (if applicable): Indicates Quota Share is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Liability Only
Check the box (if applicable): Indicates Liability Only is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Hull & Liability
Check the box (if applicable): Indicates Hull & Liability is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Hull Only
Check the box (if applicable): Indicates Hull Only is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Other Checkbox
Check the box (if applicable): Indicates the line of business subcode that further refines
the line of business code is other than those listed.
POLICY INFORMATION
Other Description
Enter text: The line of business subcode that further refines the line of business code.
AIRCRAFT INFORMATION
ACORD 333, Aircraft Schedule
Attached
Check the box (if applicable): Indicates an ACORD 333, Aircraft Schedule, is attached to
the certificate.
AIRCRAFT INFORMATION
Year
Enter year: The year of the aircraft.
AIRCRAFT INFORMATION
Make
Enter text: The manufacturer of the aircraft.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Model
Enter text: The model of the aircraft.
AIRCRAFT INFORMATION
Serial Number
Enter identifier: The serial number of the aircraft.
AIRCRAFT INFORMATION
Registration Number
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
AIRCRAFT INFORMATION
Territory
Enter text: The description of the rating territory for the aircraft.
AIRCRAFT COVERAGES
Aircraft Hull Valuation Agreed
Amount
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is the agreed amount.
AIRCRAFT COVERAGES
Aircraft Hull Valuation Insured
Amount
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is the insured amount.
AIRCRAFT COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Hull Option Description
Enter text: The description of the option being requested. Examples: All Risk Ground and
Flight, Ground and Taxi, Ground Not in Flight, Ground Not in Motion, Ground Only, In
Motion Excluding Flight, Excluding in Flight, Aircraft Storage in Hangar.
AIRCRAFT COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Hull Option Description
Enter text: The description of the option being requested. Examples: All Risk Ground and
Flight, Ground and Taxi, Ground Not in Flight, Ground Not in Motion, Ground Only, In
Motion Excluding Flight, Excluding in Flight, Aircraft Storage in Hangar.
AIRCRAFT COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Hull Option Description
Enter text: The description of the option being requested. Examples: All Risk Ground and
Flight, Ground and Taxi, Ground Not in Flight, Ground Not in Motion, Ground Only, In
Motion Excluding Flight, Excluding in Flight, Aircraft Storage in Hangar.
AIRCRAFT COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Hull Option Description
Enter text: The description of the option being requested. Examples: All Risk Ground and
Flight, Ground and Taxi, Ground Not in Flight, Ground Not in Motion, Ground Only, In
Motion Excluding Flight, Excluding in Flight, Aircraft Storage in Hangar.
AIRCRAFT COVERAGES
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
AIRCRAFT COVERAGES
Aircraft Hull Limit Applies To
Enter code: The code identifying what the limit applies to. Examples: Total Aircraft,
Aircraft while on Floats, Aircraft while on Skis, Floats, Skis.
AIRCRAFT COVERAGES
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
AIRCRAFT COVERAGES
Aircraft Hull Limit Applies To
Enter code: The code identifying what the limit applies to. Examples: Total Aircraft,
Aircraft while on Floats, Aircraft while on Skis, Floats, Skis.
AIRCRAFT COVERAGES
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT COVERAGES
Aircraft Hull Limit Applies To
Enter code: The code identifying what the limit applies to. Examples: Total Aircraft,
Aircraft while on Floats, Aircraft while on Skis, Floats, Skis.
AIRCRAFT COVERAGES
Aircraft Hull Deductible
Enter deductible: The deductible amount for aircraft hull coverage.
AIRCRAFT COVERAGES
Aircraft Hull Deductible Applies To
Enter code: The code identifying what the deductible applies to. Examples: All Other,
Collision Deductible, Comprehensive Deductible, Each Engine, Each Claim, Each and
Every Loss, Each Item, Each Tool, Ground Equipment, In Motion, Landing Gear Collapse
/ Gear Up Landing, Non-Scheduled Equipment, Not In Flight, Not In Motion, Not In Motion
While Hangared, All Other Claims, Each Aircraft, Property Damage Deductible, Each
Occurrence, Rotors In Motion, Rotors Not In Motion, Scheduled Equipment.
AIRCRAFT COVERAGES
Aircraft Hull Deductible
Enter deductible: The deductible amount for aircraft hull coverage.
AIRCRAFT COVERAGES
Aircraft Hull Deductible Applies To
Enter code: The code identifying what the deductible applies to. Examples: All Other,
Collision Deductible, Comprehensive Deductible, Each Engine, Each Claim, Each and
Every Loss, Each Item, Each Tool, Ground Equipment, In Motion, Landing Gear Collapse
/ Gear Up Landing, Non-Scheduled Equipment, Not In Flight, Not In Motion, Not In Motion
While Hangared, All Other Claims, Each Aircraft, Property Damage Deductible, Each
Occurrence, Rotors In Motion, Rotors Not In Motion, Scheduled Equipment.
AIRCRAFT COVERAGES
Aircraft Hull Deductible
Enter deductible: The deductible amount for aircraft hull coverage.
AIRCRAFT COVERAGES
Aircraft Hull Deductible Applies To
Enter code: The code identifying what the deductible applies to. Examples: All Other,
Collision Deductible, Comprehensive Deductible, Each Engine, Each Claim, Each and
Every Loss, Each Item, Each Tool, Ground Equipment, In Motion, Landing Gear Collapse
/ Gear Up Landing, Non-Scheduled Equipment, Not In Flight, Not In Motion, Not In Motion
While Hangared, All Other Claims, Each Aircraft, Property Damage Deductible, Each
Occurrence, Rotors In Motion, Rotors Not In Motion, Scheduled Equipment.
AIRCRAFT COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Liability Option
Description
Enter text: The description of the option being requested. Examples: Adjacent
Fields/CBT, BI Only, Chemical BI, Chemical BI and PD, Chemical PD, CSL BI and PD,
CSL BI and PD Excluding Passengers, CSL BI and PD Including Passengers, Excluding
Chemicals, PD Only, Total Limit.
AIRCRAFT COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT COVERAGES
Aircraft Liability Option
Description
Enter text: The description of the option being requested. Examples: Adjacent
Fields/CBT, BI Only, Chemical BI, Chemical BI and PD, Chemical PD, CSL BI and PD,
CSL BI and PD Excluding Passengers, CSL BI and PD Including Passengers, Excluding
Chemicals, PD Only, Total Limit.
AIRCRAFT COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Liability Option
Description
Enter text: The description of the option being requested. Examples: Adjacent
Fields/CBT, BI Only, Chemical BI, Chemical BI and PD, Chemical PD, CSL BI and PD,
CSL BI and PD Excluding Passengers, CSL BI and PD Including Passengers, Excluding
Chemicals, PD Only, Total Limit.
AIRCRAFT COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Liability Option
Description
Enter text: The description of the option being requested. Examples: Adjacent
Fields/CBT, BI Only, Chemical BI, Chemical BI and PD, Chemical PD, CSL BI and PD,
CSL BI and PD Excluding Passengers, CSL BI and PD Including Passengers, Excluding
Chemicals, PD Only, Total Limit.
AIRCRAFT COVERAGES
Aircraft Liability Each Occurrence
Enter limit: The each occurrence limit amount for aircraft liability coverage.
AIRCRAFT COVERAGES
Aircraft Liability Each Passenger
Enter limit: The each passenger limit amount for aircraft liability coverage.
AIRCRAFT COVERAGES
Aircraft Liability Each Person
Enter limit: The each person limit amount for aircraft liability coverage.
AIRCRAFT COVERAGES
Aircraft Liability Aggregate
Enter limit: The aggregate limit amount for aircraft liability coverage.
AIRCRAFT COVERAGES
Aircraft Liability Deductible
Enter deductible: The deductible amount for aircraft liability coverage.
AIRCRAFT COVERAGES
Aircraft Liability Deductible
Applies To
Enter code: The code identifying what the deductible applies to. Examples: All Other,
Collision Deductible, Comprehensive Deductible, Each Engine, Each Claim, Each and
Every Loss, Each Item, Each Tool, Ground Equipment, In Motion, Landing Gear Collapse
/ Gear Up Landing, Non-Scheduled Equipment, Not In Flight, Not In Motion, Not In Motion
While Hangared, All Other Claims, Each Aircraft, Property Damage Deductible, Each
Occurrence, Rotors In Motion, Rotors Not In Motion, Scheduled Equipment.
AIRCRAFT COVERAGES
Aircraft Liability Deductible
Enter deductible: The deductible amount for aircraft liability coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT COVERAGES
Aircraft Liability Deductible
Applies To
Enter code: The code identifying what the deductible applies to. Examples: All Other,
Collision Deductible, Comprehensive Deductible, Each Engine, Each Claim, Each and
Every Loss, Each Item, Each Tool, Ground Equipment, In Motion, Landing Gear Collapse
/ Gear Up Landing, Non-Scheduled Equipment, Not In Flight, Not In Motion, Not In Motion
While Hangared, All Other Claims, Each Aircraft, Property Damage Deductible, Each
Occurrence, Rotors In Motion, Rotors Not In Motion, Scheduled Equipment.
AIRCRAFT COVERAGES
Medical Payments Including Crew
Check the box (if applicable): Indicates the crew is included in the medical payments
coverage.
AIRCRAFT COVERAGES
Medical Payments Excluding Crew
Check the box (if applicable): Indicates the crew is excluded from the medical payments
coverage.
AIRCRAFT COVERAGES
Medical Payments Each Person
Enter limit: The each person limit amount for medical payments coverage.
AIRCRAFT COVERAGES
Coverage Code
Enter code: The code for the coverage.
AIRCRAFT COVERAGES
Coverage Description
Enter text: The description of other coverage (not the limit) on the policy. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s)
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Coverage Code
Enter code: The code for the coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT COVERAGES
Coverage Description
Enter text: The description of other coverage (not the limit) on the policy. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s)
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Coverage Code
Enter code: The code for the coverage.
AIRCRAFT COVERAGES
Coverage Description
Enter text: The description of other coverage (not the limit) on the policy. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s)
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Coverage Code
Enter code: The code for the coverage.
AIRCRAFT COVERAGES
Coverage Description
Enter text: The description of other coverage (not the limit) on the policy. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s)
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
NAME & ADDRESS
Name & Address
Enter text: The additional interest's full name.
NAME & ADDRESS
Enter text: The additional interest's mailing address line one.
NAME & ADDRESS
Enter text: The additional interest's mailing address line two.
NAME & ADDRESS
Enter text: The additional interest's mailing address city name.
NAME & ADDRESS
Enter code: The additional interest's mailing address state or province code.
NAME & ADDRESS
Enter code: The additional interest's mailing address postal code.
NAME & ADDRESS
Mortgagee
Check the box (if applicable): Indicates the additional interest type is a mortgagee.
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Section Name
Field Name
Field and/or Section Description
NAME & ADDRESS
Additional Insured
Check the box (if applicable): Indicates the additional interest type is an additional insured.
NAME & ADDRESS
Loss Payee
Check the box (if applicable): Indicates the additional interest type is a loss payee.
NAME & ADDRESS
Other
Check the box (if applicable): Indicates the additional interest is not any of the types listed
on the form.
NAME & ADDRESS
Other Description
Enter text: The description of the type of interest in the item.
NAME & ADDRESS
Loan Number
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
NAME & ADDRESS
Authorized Representative
Sign here: Accommodates the signature of the authorized representative (e.g. producer,
agent, broker, etc.). by all companies to issue Certificates. This is required in most states.
As used here, binders must be signed by authorized representatives of the issuing
company.
IDENTIFICATION SECTION Agency Customer Id
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
PILOT INFORMATION
Pilot #
Enter number: The producer assigned number for the pilot.
PILOT INFORMATION
Pilot Name
Enter text: The full name of the pilot.
PILOT INFORMATION
Registration Number of Assigned
Aircraft
Enter identifier: The registration number of the aircraft (a.k.a. tail number) to which the
pilot is assigned.
PILOT INFORMATION
Registration Number of Assigned
Aircraft
Enter identifier: The registration number of the aircraft (a.k.a. tail number) to which the
pilot is assigned.
PILOT INFORMATION
Registration Number of Assigned
Aircraft
Enter identifier: The registration number of the aircraft (a.k.a. tail number) to which the
pilot is assigned.
PILOT INFORMATION
Registration Number of Assigned
Aircraft
Enter identifier: The registration number of the aircraft (a.k.a. tail number) to which the
pilot is assigned.
PILOT INFORMATION
Registration Number of Assigned
Aircraft
Enter identifier: The registration number of the aircraft (a.k.a. tail number) to which the
pilot is assigned.
OPEN PILOT WARRANTY
(Carrier normally completes
description. Attach ACORD
101, Additional Remarks
Schedule, if more space is
required)
Form Number
Enter identifier: The number used by the insurer for this form.
ACORD 276 (2009/05)
11 of 13
Section Name
Field Name
Field and/or Section Description
OPEN PILOT WARRANTY
(Carrier normally completes
description. Attach ACORD
101, Additional Remarks
Schedule, if more space is
required)
Form Name
Enter text: The name of the form.
OPEN PILOT WARRANTY
(Carrier normally completes
description. Attach ACORD
101, Additional Remarks
Schedule, if more space is
required)
Description
Enter text: The description of the form.
OPEN PILOT WARRANTY
(Carrier normally completes
description. Attach ACORD
101, Additional Remarks
Schedule, if more space is
required)
Form Number
Enter identifier: The number used by the insurer for this form.
OPEN PILOT WARRANTY
(Carrier normally completes
description. Attach ACORD
101, Additional Remarks
Schedule, if more space is
required)
Form Name
Enter text: The name of the form.
OPEN PILOT WARRANTY
(Carrier normally completes
description. Attach ACORD
101, Additional Remarks
Schedule, if more space is
required)
Description
Enter text: The description of the form.
ACORD 276 (2009/05)
12 of 13
Section Name
Field Name
Field and/or Section Description
DESCRIPTION OF
OPERATIONS / REMARKS
(Attach ACORD 101,
Additional Remarks
Schedule if more space is
required)
Description of Operations
Enter text: The Aircraft Insurance Binder general remarks including the description of
operations. Attach ACORD 101, Additional Remarks Schedule, if more space is required.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
ACORD 276 (2009/05)
13 of 13