UAV Insurance Application

UAV OPERATOR INSURANCE APPLICATION
Click here for Insurance Terms & Definitions.
APPLICANT INFORMATION
How did you hear about us?*
Select how you found our website.
Insured Name*
The name of your production company or entity (or individual name if not incorporated) you would like to insure. Use the same name as on your rental quote.
Entity Type*
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*

Confirmation Email
Applicant's Business Is:*
Applicant Website:
Current Insurance Carrier:
Current Coverage Expires:*

MonthDayYear
Date
Check all that apply below:*

Applicant is an IndividualApplicant is a CorporationApplicant is a Partnership (explain below)Applicant is Other (explain below)Aircraft will be operated under FAA 333 ExemptionAircraft will be managed by other party (not Applicant)No Accidents/Incidents or Claims in last 5 yearsInsurance has never been Cancelled or Non-Renewed
Use this space provided to name each partner or the entity that best describes the applicant (which ever applies)*

UAV INFORMATION (Aircraft Frame, Flight Controller, Structures):*

	Serial Number or ID	Year	Make & Model	Specifications (Wingspan)	Specifications (Length)	Specifications (Max Weight)	Specifications (Payload Weight)	Insured Value	Liability Limit
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BASE STATION AND TRANSMITTER INFORMATION:*

PAYLOAD INFORMATION (Sensor, Downlink, Gimbal):

	Serial Number or ID:	Year	Make & Model	Specifications Payload Type and Use	Insured Value	Comments
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2.
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4.

Additional Information, Comments
Additional Information or Comments, if necessary, can be provided.
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NY License # BR-1001302

CA License # 0I36156 - dba in CA as New York Film Emporium Insurance Services
Should be Empty:

	Pilot Name	Hours Flying Types of Equipment	Employees of the Applicant	Contract Pilots	Other	Has completed Formal UAV Pilot Operator Training
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UAV OPERATOR INSURANCE APPLICATION