ACORD 340 (2009/06)

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 340 (2009/06)
Aircraft Change Request
ACORD 340, Aircraft Change Request, is used to submit requested
changes to an aircraft policy. This form may stand on its own or be attached to the
ACORD 335, Aviation Policy Change Request Applicant Information Section.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
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 Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
IDENTIFICATION SECTION Effective Date of Change
Enter date: The date on which the change should take effect.
IDENTIFICATION SECTION Effective Time of Change
Enter time: The effective time of the policy change.
IDENTIFICATION SECTION Effective Time AM
Check the box (if applicable): Indicates the effective time of the policy change is in the
morning (AM).
IDENTIFICATION SECTION Effective Time PM
Check the box (if applicable): Indicates the effective time of the policy change is in the
afternoon or evening (PM).
IDENTIFICATION SECTION Named Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
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.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Aircraft #
Enter identifier: The producer assigned aircraft number.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Base Airport ID
Enter code: The Federal Aviation Administration's designator for the airport where this
aircraft is based (e.g. ORD - O'Hare International Airport).
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Reg Number
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Year
Enter year: The year of the aircraft.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Make
Enter text: The manufacturer of the aircraft.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Model
Enter text: The model of the aircraft.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Serial #
Enter identifier: The serial number of the aircraft.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Aircraft Type
Enter code: The type of aircraft. Valid codes are:
1 - Glider
2 - Balloon
3 - Blimp-Dirigible
4 - Fixed Wing Single Engine
5 - Fixed Wing Multi Engine
6 - Rotorcraft
7 - Weight Shift Control
8 - Powered Parachute
9 - Gyroplane
OT - Other
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Aircraft Use
Enter code: The primary use of the aircraft (i.e. AA - Air Ambulance, BT - Banner Towing,
CH - Charter, CO - Cargo Only, FC - Full Commercial, IA - Industrial Aid, PB - Pleasure
and Business, etc.).
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Engine Type
Enter code: The type of engine on the aircraft.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Horsepower
Enter number: The horsepower of the engine used on the aircraft.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Engine Hours 1
Enter number: The number of flight hours on engine 1.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Engine Hours 2
Enter number: The number of flight hours on engine 2.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Engine Hours 3
Enter number: The number of flight hours on engine 3.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Engine Hours 4
Enter number: The number of flight hours on engine 4.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Hrs. Last 12 Mos.
Enter number: The total number of hours logged for the past 12 months.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Seating Cap.
Enter number: Enter the seating capacity of the aircraft.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Value
Enter amount: Enter the value of the aircraft.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Hangared
Check the box (if applicable): Indicates the aircraft is stored in a hangar.
AIRCRAFT INFORMATION
Moored
Check the box (if applicable): Indicates the aircraft is moored.
AIRCRAFT INFORMATION
Tied-Out
Check the box (if applicable): Indicates the aircraft is tied out.
AIRCRAFT INFORMATION
Other Storage
Check the box (if applicable): Indicates the aircraft is stored in a manner other than those
listed.
AIRCRAFT INFORMATION
Describe Other Storage
Enter text: The description of the storage area used for the aircraft.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Airframe Hours
Enter number: The number of hours of the airframe.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Date of Last Annual
Enter date: The date of the last annual inspection.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Territory
Enter text: The description of the rating territory for the aircraft.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
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 INFORMATION
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 INFORMATION
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
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 INFORMATION
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 INFORMATION
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Hull Deductible
Enter deductible: The deductible amount for aircraft hull coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Hull Deductible
Enter deductible: The deductible amount for aircraft hull coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Hull Deductible
Enter deductible: The deductible amount for aircraft hull coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Hull Premium
Enter amount: The premium amount for aircraft hull coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Liability Each Occurrence
Enter limit: The each occurrence limit amount for aircraft liability coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Aircraft Liability Each Passenger
Enter limit: The each passenger limit amount for aircraft liability coverage.
AIRCRAFT INFORMATION
Aircraft Liability Each Person
Enter limit: The each person limit amount for aircraft liability coverage.
AIRCRAFT INFORMATION
Aircraft Liability Aggregate
Enter limit: The aggregate limit amount for aircraft liability coverage.
AIRCRAFT INFORMATION
Aircraft Liability Deductible
Enter deductible: The deductible amount for aircraft liability coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Liability Deductible
Enter deductible: The deductible amount for aircraft liability coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Aircraft Liability Premium
Enter amount: The premium amount for aircraft liability coverage.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Medical Payments Including Crew
Check the box (if applicable): Indicates the crew is included in the medical payments
coverage.
AIRCRAFT INFORMATION
Medical Payments Excluding Crew
Check the box (if applicable): Indicates the crew is excluded from the medical payments
coverage.
AIRCRAFT INFORMATION
Medical Payments Each Person
Enter limit: The each person limit amount for medical payments coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Medical Payments Premium
Enter amount: The premium amount for medical payments coverage.
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Coverage Code
Enter code: The code for the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Premium
Enter amount: The premium amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Coverage Code
Enter code: The code for the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Premium
Enter amount: The premium amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Coverage Code
Enter code: The code for the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Premium
Enter amount: The premium amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRCRAFT INFORMATION
Coverage Code
Enter code: The code for the coverage.
AIRCRAFT INFORMATION
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 INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT INFORMATION
Option Description
Enter text: The description of the option being requested.
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Deductible
Enter deductible: The deductible amount for the coverage.
AIRCRAFT INFORMATION
Applies To
Enter code: The code identifying what the deductible applies to.
AIRCRAFT INFORMATION
Premium
Enter amount: The premium amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
OPEN PILOT WARRANTY
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
OPEN PILOT WARRANTY
Form Number
Enter identifier: The number used by the insurer for this form.
OPEN PILOT WARRANTY
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
OPEN PILOT WARRANTY
Form Name
Enter text: The name of the form.
OPEN PILOT WARRANTY
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
OPEN PILOT WARRANTY
Description
Enter text: The description of the form.
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Section Name
Field Name
Field and/or Section Description
OPEN PILOT WARRANTY
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
OPEN PILOT WARRANTY
Form Number
Enter identifier: The number used by the insurer for this form.
OPEN PILOT WARRANTY
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
OPEN PILOT WARRANTY
Form Name
Enter text: The name of the form.
OPEN PILOT WARRANTY
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
OPEN PILOT WARRANTY
Description
Enter text: The description of the form.
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Section Name
Field Name
Field and/or Section Description
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
Loc #
Enter number: The producer assigned number of the location.
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
Airport ID
Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD -
O'Hare International Airport).
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
Airport Name
Enter text: The full name of the location.
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Section Name
Field Name
Field and/or Section Description
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
City
Enter text: The city of the physical location.
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
State
Enter code: The state or province of the physical location.
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
Private
Check the box (if applicable): Indicates the airport is a private airport.
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Section Name
Field Name
Field and/or Section Description
BASE AIRPORT
INFORMATION
Public
Check the box (if applicable): Indicates the airport is a public airport.
BASE AIRPORT
INFORMATION
Restricted
Check the box (if applicable): Indicates the airport is a restricted airport.
BASE AIRPORT
INFORMATION
Other Airport Type
Check the box (if applicable): Indicates the airport type is other than those listed.
BASE AIRPORT
INFORMATION
Describe Other Airport Type
Enter text: The description of the type of airport.
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
Hangared
Check the box (if applicable): Indicates the hangars are available for aircraft storage.
BASE AIRPORT
INFORMATION
Moored
Check the box (if applicable): Indicates aircraft are moored at the airport.
BASE AIRPORT
INFORMATION
Tied-Out
Check the box (if applicable): Indicates aircraft are tied out at the airport.
BASE AIRPORT
INFORMATION
Other Storage
Check the box (if applicable): Indicates the airport has aircraft storage facilities other than
those listed.
BASE AIRPORT
INFORMATION
Describe Other Storage
Enter text: The description of the aircraft storage facilities available at the airport.
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Section Name
Field Name
Field and/or Section Description
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
Length of Longest Runway
Enter number: The length of the longest runway in feet.
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
Width of Longest Runway
Enter number: The width of the longest runway in feet.
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
Are runways paved?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are the runways paved?.
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Section Name
Field Name
Field and/or Section Description
BASE AIRPORT
INFORMATION
If runways are not paved, explain.
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
BASE AIRPORT
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BASE AIRPORT
INFORMATION
Are runways lighted?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are runways lighted?.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
CORPORATE NON-OWNED
COMPANY APPLICANTS
Flying Hours Last Year:
Enter year: The year for the flying hours you are reporting for last year.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Flying Hours Next Year:
Enter year: The year for the flying hours you are reporting for next year.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED
COMPANY APPLICANTS
Annual Last Year
Enter number: The total annual flying hours for last year.
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Section Name
Field Name
Field and/or Section Description
CORPORATE NON-OWNED
COMPANY APPLICANTS
Annual Next Year
Enter number: The estimated total annual flying hours for next year.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED Rented and use of employee
COMPANY APPLICANTS
owner aircraft. Last Year
Enter number: The number of flying hours for rented and use of employee owner aircraft
for last year.
CORPORATE NON-OWNED Rented and use of employee
COMPANY APPLICANTS
owner aircraft. Next Year
Enter number: The estimated number of flying hours for rented and use of employee
owner aircraft for next year.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED Chartered aircraft with non-
COMPANY APPLICANTS
employee pilots Last Year
Enter number: The number of flying hours for chartered aircraft with non-employee pilots
for last year.
CORPORATE NON-OWNED Chartered aircraft with non-
COMPANY APPLICANTS
employee pilots Next Year
Enter number: The estimated number of flying hours for chartered aircraft with non-
employee pilots for next year.
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Section Name
Field Name
Field and/or Section Description
CORPORATE NON-OWNED
COMPANY APPLICANTS
Employees
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED
COMPANY APPLICANTS
Family Members
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED
COMPANY APPLICANTS
Guests
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED Average Number of Passengers
COMPANY APPLICANTS
Each Trip
Enter number: The average number of passengers on each trip.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED
COMPANY APPLICANTS
Branch Offices
Enter number: The number of branch offices.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
CORPORATE NON-OWNED
COMPANY APPLICANTS
Total Employees
Enter number: The number of total employees.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED
COMPANY APPLICANTS
Employees who are pilots
Enter number: The number of employees who are pilots.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED Employees employed in a pilot
COMPANY APPLICANTS
capacity.
Enter number: The number of employees employed in a pilot capacity.
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Section Name
Field Name
Field and/or Section Description
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED
COMPANY APPLICANTS
Employees owning aircraft.
Enter number: The number of employees owning aircraft.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED Employees whose regular duties
COMPANY APPLICANTS
include aircraft travel.
Enter number: The number of employees whose regular duties include aircraft travel.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
CORPORATE NON-OWNED Employees owning aircraft used
COMPANY APPLICANTS
on company business
Enter number: The number of employees owning aircraft use on company business
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED Liability Limit carried on primary
COMPANY APPLICANTS
basis
Enter limit: The liability limit carried on a primary basis for employees owning aircraft used
on company business.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED Is insured listed as an additional
COMPANY APPLICANTS
insured?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, If an employee flies their own aircraft on company business, is the applicant
listed as an additional insured on the employees' policy?.
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Section Name
Field Name
Field and/or Section Description
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED
COMPANY APPLICANTS
Aircraft Owned by Company
Enter number: The number of aircraft owned by the company.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
CORPORATE NON-OWNED
COMPANY APPLICANTS
Make
Enter text: The name of the manufacturer of the aircraft.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
CORPORATE NON-OWNED
COMPANY APPLICANTS
Model
Enter text: The model name of the aircraft.
CORPORATE NON-OWNED 1. Any charters or rentals for more
COMPANY APPLICANTS
than seven consecutive days?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any charters or rentals for more than seven consecutive days?.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
CORPORATE NON-OWNED aircraft over eight-place including
COMPANY APPLICANTS
2. Any use of jets, helicopters, or
crew?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any use of jets, helicopters or aircraft over eight-place including crew?.
CORPORATE NON-OWNED
COMPANY APPLICANTS
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
CORPORATE NON-OWNED included as an additional insured
COMPANY APPLICANTS
3. Is the insured, as a customer,
on the charter primary policy?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is insured, as a customer, included as an additional insured on the charter
primary policy?.
CORPORATE NON-OWNED a) If yes, has a certificate of
COMPANY APPLICANTS
insurance been obtained?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, If insured, as a customer, is included as an additional insured on the charter
primary policy, has a certificate of insurance been obtained?.
CORPORATE NON-OWNED 4. Liability limit on rented or
COMPANY APPLICANTS
chartered aircraft:
Enter limit: The liability limit on rented or chartered aircraft.
TURBINE AIRCRAFT
Flying Hours Last Year:
Enter year: The year for the flying hours you are reporting for last year.
TURBINE AIRCRAFT
Flying Hours Next Year:
Enter year: The year for the flying hours you are reporting for next year.
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Section Name
Field Name
Field and/or Section Description
TURBINE AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TURBINE AIRCRAFT
Annual Last Year
Enter number: The total annual flying hours for last year.
TURBINE AIRCRAFT
Annual Next Year
Enter number: The estimated total annual flying hours for next year.
TURBINE AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TURBINE AIRCRAFT
Rented and use of employee
owner aircraft. Last Year
Enter number: The number of flying hours for rented and use of employee owner aircraft
for last year.
TURBINE AIRCRAFT
Rented and use of employee
owner aircraft. Next Year
Enter number: The estimated number of flying hours for rented and use of employee
owner aircraft for next year.
TURBINE AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
TURBINE AIRCRAFT
Chartered aircraft with non-
employee pilots Last Year
Enter number: The number of flying hours for chartered aircraft with non-employee pilots
for last year.
TURBINE AIRCRAFT
Chartered aircraft with non-
employee pilots Next Year
Enter number: The estimated number of flying hours for chartered aircraft with non-
employee pilots for next year.
TURBINE AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TURBINE AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TURBINE AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
TURBINE AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TURBINE AIRCRAFT
Average Number of Passengers
Each Trip
Enter number: The average number of passengers on each trip.
TURBINE AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TURBINE AIRCRAFT
Maintenance Facility
Enter text: The maintenance facility used for the aircraft.
TURBINE AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TURBINE AIRCRAFT
Maintenance Program
Enter text: The maintenance program used on the aircraft.
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Section Name
Field Name
Field and/or Section Description
TURBINE AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TURBINE AIRCRAFT
Is the aircraft equipped with a
traffic and/or terrain collision
avoidance system? If yes, enter
type:
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the aircraft equipped with a traffic and/or terrain collision avoidance system?.
As used here, if yes, enter type of traffic and / or terrain collision avoidance system.
TURBINE AIRCRAFT
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AGRICULTURAL AIRCRAFT Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AGRICULTURAL AIRCRAFT aerial application business.
Enter names used in any former
Enter text: The name used in any former aerial application business.
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Section Name
Field Name
Field and/or Section Description
AGRICULTURAL AIRCRAFT Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AGRICULTURAL AIRCRAFT aerial application business.
Enter names used in any former
Enter text: The name used in any former aerial application business.
AGRICULTURAL AIRCRAFT Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AGRICULTURAL AIRCRAFT aerial application business.
Enter names used in any former
Enter text: The name used in any former aerial application business.
AGRICULTURAL AIRCRAFT Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AGRICULTURAL AIRCRAFT aerial application business.
Enter names used in any former
Enter text: The name used in any former aerial application business.
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Section Name
Field Name
Field and/or Section Description
AGRICULTURAL AIRCRAFT Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AGRICULTURAL AIRCRAFT Agricultural Operations
Num Years Conducting Aerial
Enter number: The number of years the insured has been conducting aerial agricultural
operations.
AGRICULTURAL AIRCRAFT Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AGRICULTURAL AIRCRAFT Home State of Operation
Enter code: The state or province code for the home state of operations.
AGRICULTURAL AIRCRAFT Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AGRICULTURAL AIRCRAFT States
Describe Operations in Other
Enter text: The description of operations conducted in other states.
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Section Name
Field Name
Field and/or Section Description
AGRICULTURAL AIRCRAFT Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AGRICULTURAL AIRCRAFT completed
If you participate in NAAA PAASS
safety program, enter last date
Enter date: The date the safety program was completed. This is date the National
Agricultural Aviation Association (NAAA) Professional Aerial Application Support System
(PAASS) Safety Program was completed.
AGRICULTURAL AIRCRAFT Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AGRICULTURAL AIRCRAFT or operated by you
Number of Aircraft owned, leased
Enter number: The number of aircraft owned, leased or operated by the insured.
AGRICULTURAL AIRCRAFT etc.)
1. Do you spray: Picloram
Formulations (i.e. Tordon, Grazon,
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Do you spray - Picloram formulations (i.e. Tordon, Grazon, etc.)?.
AGRICULTURAL AIRCRAFT Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AGRICULTURAL AIRCRAFT provide any chemicals?
2. Do you sell, distribute, or
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Do you sell, distribute, or provide any chemicals?.
AGRICULTURAL AIRCRAFT Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
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Section Name
Field Name
Field and/or Section Description
AGRICULTURAL AIRCRAFT agricultural aviation association?
3. Are you a member of your state
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are you a member of your State Agricultural Aviation Association?.
AGRICULTURAL AIRCRAFT association?
4. Are you a member of any other
state agricultural aviation
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are you a member of any other State Agricultural Aviation Association?.
AGRICULTURAL AIRCRAFT Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AGRICULTURAL AIRCRAFT Association?
5. Are you a member of the
National Agricultural Aviation
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are you a member of the National Agricultural Aviation Association?.
AGRICULTURAL AIRCRAFT compensation claims?
6. Have you had any workers
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Have you had any Workers Compensation claims?.
AGRICULTURAL AIRCRAFT Date of Loss
Enter date: The date that the loss occurred.
AGRICULTURAL AIRCRAFT Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AGRICULTURAL AIRCRAFT cited or fined?
7. Have any of your pilots been
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Have any of your pilots been cited or fined?.
AGRICULTURAL AIRCRAFT Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AGRICULTURAL AIRCRAFT residential (or populated) areas?
8. Do you spray over any
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Do you spray over any residential (or populated) areas?.
AGRICULTURAL AIRCRAFT Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AGRICULTURAL AIRCRAFT 9. Do you spray right-of-ways?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Do you spray right-of-ways?.
AGRICULTURAL AIRCRAFT Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AGRICULTURAL AIRCRAFT Describe additional uses.
Enter text: The description of additional uses for the aircraft.
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
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Additional Insured
Check the box (if applicable): Indicates the additional interest type is an additional insured.
ADDITIONAL INTERESTS
Breach of Warranty
Check the box (if applicable): Indicates the additional interest type is a breach of warranty.
ADDITIONAL INTERESTS
Co-Owner
Check the box (if applicable): Indicates the additional interest type is a co-owner.
ADDITIONAL INTERESTS
Leaseback Owner
Check the box (if applicable): Indicates the additional interest type is a leaseback owner.
ADDITIONAL INTERESTS
Lienholder
Check the box (if applicable): Indicates the additional interest type is a lien holder.
ADDITIONAL INTERESTS
Loss Payee
Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTERESTS
Mortgagee
Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTERESTS
Other Additional Interest
Check the box (if applicable): Indicates the additional interest is not any of the types listed
on the form.
ADDITIONAL INTERESTS
Describe Other Additional Interest
Enter text: The description of the type of interest in the item.
ADDITIONAL INTERESTS
Reason for Interest
Enter text: The description for the interest in the item.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
Rank
Enter number: The ranking of 'this' additional interest when multiple additional interests
are associated with the same item.
ADDITIONAL INTERESTS
Evidence: Certificate
Check the box (if applicable): Indicates if the additional interest requires a Certificate of
Insurance,
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Name
Enter text: The additional interest's full name.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Street
Enter text: The additional interest's mailing address line one.
ADDITIONAL INTERESTS
Street (Continued)
Enter text: The additional interest's mailing address line two.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
City
Enter text: The additional interest's mailing address city name.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
State
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Zip
Enter code: The additional interest's mailing address postal code.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Country
Enter code: The additional interest's country code.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Reference # / Loan #
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Interest End Date
Enter date: The date the interest holder's interest terminates.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Lien Amount
Enter amount: The amount of the loan.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Phone
Enter number: The primary phone number of the additional interest.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Fax
Enter number: The primary fax number of the additional interest.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
E-mail Address
Enter text: The primary e-mail address for the additional interest.
ADDITIONAL INTERESTS
Location
Enter number: The producer assigned number of the location which has an additional
interest.
ADDITIONAL INTERESTS
Building
Enter number: The producer assigned number of the building which has an additional
interest.
ADDITIONAL INTERESTS
Airport
Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD -
O'Hare International Airport).
ADDITIONAL INTERESTS
Aircraft
Enter number: The producer assigned number of the aircraft which has an additional
interest.
ADDITIONAL INTERESTS
Item Class
Enter text: The description of the property class of the scheduled item (i.e. Jewelry, Furs,
Contractors Equipment, etc.).
ADDITIONAL INTERESTS
Item
Enter number: The producer assigned number of the scheduled item which has an
additional interest.
ADDITIONAL INTERESTS
Item Description
Enter text: The description of the item which has an additional interest.
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY 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.
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Section Name
Field Name
Field and/or Section Description
POLICY 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.
POLICY COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Hull Deductible
Enter deductible: The deductible amount for aircraft hull coverage.
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Section Name
Field Name
Field and/or Section Description
POLICY 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.
POLICY COVERAGES
Aircraft Hull Deductible
Enter deductible: The deductible amount for aircraft hull coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Hull Deductible
Enter deductible: The deductible amount for aircraft hull coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Hull Premium
Enter amount: The premium amount for aircraft hull coverage.
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY 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
POLICY 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.
POLICY COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Liability Each Occurrence
Enter limit: The each occurrence limit amount for aircraft liability coverage.
POLICY COVERAGES
Aircraft Liability Each Passenger
Enter limit: The each passenger limit amount for aircraft liability coverage.
POLICY COVERAGES
Aircraft Liability Each Person
Enter limit: The each person limit amount for aircraft liability coverage.
POLICY COVERAGES
Aircraft Liability Aggregate
Enter limit: The aggregate limit amount for aircraft liability coverage.
POLICY COVERAGES
Aircraft Liability Deductible
Enter deductible: The deductible amount for aircraft liability coverage.
POLICY 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.
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Aircraft Liability Deductible
Enter deductible: The deductible amount for aircraft liability coverage.
POLICY 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.
POLICY COVERAGES
Aircraft Liability Premium
Enter amount: The premium amount for aircraft liability coverage.
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Medical Payments Including Crew
Check the box (if applicable): Indicates the crew is included in the medical payments
coverage.
POLICY COVERAGES
Medical Payments Excluding Crew
Check the box (if applicable): Indicates the crew is excluded from the medical payments
coverage.
POLICY COVERAGES
Medical Payments Each Person
Enter limit: The each person limit amount for medical payments coverage.
POLICY COVERAGES
Medical Payments Premium
Enter amount: The premium amount for medical payments coverage.
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Builder's Risk 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
POLICY COVERAGES
Builder's Risk Option Description
Enter text: The description of the option being requested.
POLICY COVERAGES
Builder's Risk Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Builder's Risk Option Description
Enter text: The description of the option being requested.
POLICY COVERAGES
Builder's Risk Limit
Enter limit: The limit amount for builder's risk coverage.
POLICY COVERAGES
Builder's Risk Limit Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Builder's Risk Limit
Enter limit: The limit amount for builder's risk coverage.
POLICY COVERAGES
Builder's Risk Limit Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Builder's Risk Deductible
Enter deductible: The deductible amount for builder's risk coverage.
POLICY COVERAGES
Builder's Risk Deductible Applies
To
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Builder's Risk Deductible
Enter deductible: The deductible amount for builder's risk coverage.
POLICY COVERAGES
Builder's Risk Deductible Applies
To
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Builder's Risk Premium
Enter amount: The premium amount for builder's risk coverage.
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
ACORD 340 (2009/06)
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Section Name
Field Name
Field and/or Section Description
POLICY COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
POLICY COVERAGES
Coverage Code
Enter code: The code for the coverage.
POLICY 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)
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Options Check Box
Check the box (if applicable): Indicates a coverage option applies to the coverage.
POLICY COVERAGES
Describe Option
Enter text: The description of the option being requested.
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Limit
Enter limit: The limit amount for the coverage.
POLICY COVERAGES
Limit Applies to:
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
POLICY COVERAGES
Deductible Applies to:
Enter code: The code identifying what the deductible applies to.
POLICY COVERAGES
Premium
Enter amount: The premium amount for the coverage.
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
GENERAL INFORMATION
1. Does the applicant own any
other aircraft not listed?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the applicant own any other aircraft not listed?.
GENERAL INFORMATION
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Aircraft Registration #
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
GENERAL INFORMATION
2. Does the aircraft have other
than a standard airworthiness
certificate in full force and effect?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the aircraft have other than a standard airworthiness certificate in full
force and effect?.
GENERAL INFORMATION
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Aircraft Registration #
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
GENERAL INFORMATION
3. Has aircraft been equipped with
any modifications not provided by
the original manufacturer that alter
the flying characteristics?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Has aircraft been equipped with any modifications not provided by the original
aircraft manufacturer that alter the flying characteristics?.
GENERAL INFORMATION
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Aircraft Registration #
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
GENERAL INFORMATION
4. Do you anticipate the aircraft to
be operated outside the
contiguous United States?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Do you anticipate aircraft to be operated outside the contiguous United
States?.
GENERAL INFORMATION
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Aircraft Registration #
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
GENERAL INFORMATION
5. Is there any unrepaired damage
to the aircraft?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is there any unrepaired damage to the aircraft?.
GENERAL INFORMATION
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Aircraft Registration #
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
GENERAL INFORMATION
6. Will the aircraft be used for any
purpose(s) for which a charge is
made other than those allowed in
far part 91?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Will aircraft be used for any purpose(s) for which a charge is made other than
those allowed in FAR Part 91?.
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Section Name
Field Name
Field and/or Section Description
GENERAL INFORMATION
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Aircraft Registration #
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
GENERAL INFORMATION
7. Will the aircraft be used for
other than the transportation of
persons (such as hunting, aerial
applications, patrol, research,
etc.)?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Will aircraft be used for other than transportation of persons (such as hunting,
aerial applications, patrol, research, etc.)?.
GENERAL INFORMATION
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Aircraft Registration #
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
GENERAL INFORMATION
8. Will the aircraft be used for
student or pilot instruction other
than for recurrent training of
named pilots? If yes, provide all
details:
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Will aircraft be used for student or pilot instruction other than for recurrent
training of named pilots?
GENERAL INFORMATION
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Aircraft Registration #
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
GENERAL INFORMATION
9. Will the aircraft be normally
operated from other than paved
airports?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Will aircraft be normally operated from other than paved airports?.
GENERAL INFORMATION
Where
Enter text: The description of where the aircraft is used other than paved airports.
GENERAL INFORMATION
Purpose
Enter text: The purpose the aircraft is used in locations other than paved airports.
GENERAL INFORMATION
Frequency
Enter text: The frequency the aircraft is used in locations other than paved airports.
GENERAL INFORMATION
Aircraft Registration #
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
GENERAL INFORMATION
10. Will the aircraft be operated off
airport?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Will the aircraft be operated off airport?.
GENERAL INFORMATION
Explain
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Aircraft Registration #
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
REMARKS (Attached
ACORD 101, Additional
Remarks Schedule, if more
space is required)
Remarks
Enter text: The general remarks associated with the aircraft line of business. Use this
section to provide any additional information required for underwriting or rating. Attach
ACORD 101, Additional Remarks Schedule, is more space is required.
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Section Name
Field Name
Field and/or Section Description
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
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