AVIATION Questionnaire

Transcription

1 AVIATION Questionnaire Producer Name Phone Date Client Name DOB Male Female SS# Face Amount Max Premium $ /yr UL WL Survivorship Term Length Current height Current weight Weight change in last year? Does the client currently use tobacco? Yes No If yes, what type? cigarettes nicotine patch pipe snuff Nicorette gum e-cig cigars Frequency per month If no, what was the last date he/she used tobacco? Never Quit date Type last used AVIATION DETAILS Hours flown as a pilot or copilot Commercial (flying for pay) Contemplated Next 12 Months Past 12 Months Months Ago Total Lifetime Hours Scheduled Passenger Airlines Employer Owned Aircraft Nonscheduled or Charter Crop Dusting or Aerial Spraying Student Instruction Exhibition or Stunt Flying Other (specify) Total logged hours Certificate license: Student, date first obtained student pilot s certificate Private, date first obtained private pilot s certificate Commercial, date first obtained commercial pilot s certificate ATR Other (specify) Does the client have an Instrument Flight Rating? (IFR) Yes No If yes, explain below Other ratings Class of FAA medical certification Date of last FAA exam Are there any limitations or duration limits on FAA medical certificate? Yes No If yes, explain below Advisor Services of America

2 Civilian Aviation Does the proposed insured use non-public airports? Yes No If yes, please provide details below. Any past or future plans to fly outside the USA Yes No If yes, please provide details below. Any past or future intentions to fly a prototype, experimental, or personally built aircraft, rotocraft, balloon, or glider? Yes No If yes, please provide details below. Does the client fly an aircraft specifically designed or built for aerial application? Yes No If yes, please provide make, model, year, and hours Military Aviation Name of military organization Is proposed insured a pilot? Yes No If no, provide details of capacity onboard aircraft below. Type of aircraft flown Expected duration flying this type of aircraft Previous type of aircraft flown Date of last flight Does proposed insured fly for proficient only? Yes No If yes, please provide number of hours flown this year Aviation Exclusion Would client consider an aviation exclusion included in the policy to exclude coverage for aviation activities? Yes No OTHER UNDERWRITING CONCERNS Have you been previously declined or rated for life coverage? Yes No Informally? Yes No If yes, provide carrier name, date, & results of application Insured s exercise regimen (frequency & type) Insured s other health problems (e.g. cancer, diabetes, arrhythmia, CAD, Carotid Disease, etc.) List Insured s family members that were diagnosed with heart disease, cancer, diabetes, stroke, or TIA. (Include relationships to insured, age at diagnosis, and current age if still living) List all medication (quantity taken, frequency) Advisor Services of America

3 UNDERWRITING Civilian Aviation Rating Schedule Civilian Aviation Guidelines The process of determining the appropriate aviation rating and preferred classification is a two-step process: Step 1: Consult the appropriate rating schedule to determine if an aviation extra rating is required and to determine which preferred classes may be available. Rating Schedule Pilots flying for hire (compensated) on page 2. Rating Schedule Pilots not flying for hire (non-compensated) on pages 3 and 4. Step 2: Take the information from step 1 and apply it to the Preferred Underwriting Criteria schedule (below). Base ratings, as noted in these schedules, apply to Federal Aviation Administration (FAA) certified pilots only. Please contact Underwriting for consideration of a foreign pilot. Preferred Underwriting Criteria Preferred Best 4No ratable aviation activities 4One of the following certificate types (current and valid): Private Commercial Airline Transport Pilot (ATP) 4Age 30 and older 4Minimum 1,000 total hours or 5+ years aviation history as a nonstudent certified pilot 4No FAA violations 4Minimum 100 hours in current make/model of aircraft 4Must possess a valid medical certificate without restrictions or special issuance (other than requiring the use of corrective lenses) 4Limited to pilots of fixed-wing, powered aircraft flights only (no rotorcraft/glider flights) Preferred Non-Tobacco/Preferred Smoker 4No ratable aviation activities 4One of the following certificate types (current and valid): Private Commercial Airline Transport Pilot (ATP) 4Age 30 and older 4Minimum 1,000 total hours or 5+ years aviation history as a nonstudent certified pilot 4No FAA violations within the past 5 years 4Minimum 100 hours in current make/model of aircraft Non-Smoker Plus 4No occupation-related aviation activities 4One of the following certificate types (current and valid): Private Commercial Airline Transport Pilot (ATP) 4Age 25 and older 4Minimum 600 total hours or 3+ years aviation history as a nonstudent certified pilot 4No FAA violations within the past 3 years

4 CIVILIAN AVIATION RATING SCHEDULE Flying for Hire Pilots and Crew Members In all cases, yearly flying time will be determined by considering the number of hours the proposed insured has flown in the past two years, as well as the number of hours he or she expects to fly in the next 12 months as both a pilot and crew member. Pilots and crew members flying for hire and employed by those mentioned below: U.S. or Canadian certified scheduled air carriers: Aircraft total capacity less than 10 seats $2.50 Smoker to Non-Smoker Aircraft total capacity 10 or more seats No aviation extra required Smoker to Preferred Best Foreign air carriers excluding Canadian carriers (e.g., Contact Underwriting British Airways, Qantas, Ryanair, Air India, Emirates, etc.) Corporate-owned aircraft (including fractional ownership corporations [e.g., Net Jets]): Jet-powered or fixed-wing aircraft with 10 or more seats No aviation extra required Smoker to Preferred Best Others $2.50 Smoker to Non-Smoker Others Contact Underwriting Pilots and crew members engaged in other commercial flight occupations 1 : Aerobatics $10.00 Smoker to Non-Smoker Crop spraying Purpose-built agricultural application aircraft/rotorcraft: Less than 1,000 hours experience in application flight $5.00 Smoker to Non-Smoker 1,000 or more hours experience in application flight $5.00 Smoker to Non-Smoker Modified conventional aircraft/rotorcraft: Less than 1,000 hours experience in application flight $7.50 Smoker to Non-Smoker 1,000 or more hours experience in application flight $5.00 Smoker to Non-Smoker Pilot instruction for compensation $2.50 Smoker to Non-Smoker Firefighting: Smokejumpers $3.75 Smoker to Non-Smoker Others $7.50 Smoker to Non-Smoker Test piloting or other unusual hazard Contact Underwriting Occupation Group A Air ambulance, demonstration (sales/service), ferry service (within U.S. & Canada), fish & game, law enforcement, mapping, medical airlift, mining, photography, pipeline, power & telephone line inspection, radio & TV reporting, search & rescue, sightseeing, weather control: Up to and including 350 hours yearly flying time $3.75 Smoker to Non-Smoker More than 350 hours yearly flying time $5.00 Smoker to Non-Smoker Occupation Group B Banner towing, bush flying, construction, glider towing, herding/hunting, offshore oil rig service: Up to and including 350 hours yearly flying time $5.00 Smoker to Non-Smoker More than 350 hours yearly flying time $7.50 Smoker to Non-Smoker

5 CIVILIAN AVIATION RATING SCHEDULE Not Flying for Hire Pilots In all cases, yearly flying time will be determined by considering the number of hours the proposed insured has flown in the past two years, as well as the number of hours that he or she expects expect to fly in the next 12 months as both a pilot and crew member. Flying conventional manufactured fixed-wing and rotorcraft 1 : Student pilots $2.50 Smoker to Non-Smoker Pilots with sport or recreational certificates No aviation extra required Smoker to Non-Smoker Pilots with private, commercial, or ATP certificates: Up to and including 300 hours total flight time $2.50 Smoker to Non-Smoker Plus More than 300 hours total flight time: Less than 30 hours yearly flying time $ Smoker to Preferred Best hours yearly flying time No aviation extra required Smoker to Preferred Best More than 300 hours yearly flying time 2 $ Smoker to Non-Smoker Plus Performing any aerobatic maneuvers $1.25 Smoker to Non-Smoker Plus Performing any non-compensated pilot instruction in the air $1.25 Smoker to Non-Smoker Plus Non-conventional private aviation activities 1 : Ultralights (weight-shift aircraft) 1 : Certified pilots: Flights up to and including 3,000 ft. $2.50 Smoker to Non-Smoker Plus Flights over 3,000 ft. $5.00 Smoker to Non-Smoker Plus Hobbyist no certification: Flights up to and including 3,000 ft. $5.00 Smoker to Non-Smoker Plus Flights over 3,000 ft. $7.50 Smoker to Non-Smoker Plus Blimps & rigid airships No aviation extra required Smoker to Preferred Non-Tobacco

6 CIVILIAN AVIATION RATING SCHEDULE Not Flying for Hire Pilots (Continued) Lighter-than-air flight: Balloons: Hot air: Tethered No aviation extra required Smoker to Preferred Non-Tobacco Free flight normal terrain (suburban/rural) $1.25 Smoker to Non-Smoker Plus Free flight rugged terrain (mountains/remote areas) $5.00 Smoker to Non-Smoker Free flight experimental/record attempts/over ocean Helium Decline Decline 1 When aircraft is listed as experimental (homebuilt, amateur-built, kit-built, etc.): Experience Less than 50 hours total flight in experimental model More than 50 hours total flight in experimental model Adjustment Increase aviation extra by two classes Use appropriate aviation extra 2 Non-compensated hours flown by proposed insureds flying for their own business (where piloting a company aircraft is not their primary job) may be considered similarly to commercial pilots hours, and will not be counted against private aviation activities if they fly a corporate jet type of aircraft. 3 One class reduction with instrument rating, no other unfavorable aviation factors, and the following experience: 100 hours of non-simulated Instrument Flight Rules (IFR) flight time and 100 hours in current make/model aircraft. Availability of insurance and rates will vary based on the satisfaction of underwriting criteria. Underwriting rules are subject to change at our discretion.

7 Military Aviation Rating Schedule Determine Appropriate Aircraft/Mission Classification for Primary Aircraft Flown Military aircraft are given specific designations by the Department of Defense known as Mission Design Series (MDS) that identify their design and purpose. All aircraft have a mission designation, some aircraft have more than one mission designation, and others have both a mission and aircraft designation. In order to properly assess the risk present for military pilots and crew members, determine the appropriate designations from the charts below. MISSION DESIGNATION A Attack K Tanker U Utility B Bomber M Multi-Mission V VIP C Cargo (Transport) O Observation X Experimental E Special electronic installation P Patrol Y Experimental F Fighter S Anti-Submarine H Search & Rescue T Trainer AIRCRAFT DESIGNATION H Helicopter V Vertical takeoff and/or landing For example, for pilots of: F-22 (Fighter mission designation) C-5 (Cargo [Transport] mission designation) MV-22 (Multi-Mission mission designation with a Vertical takeoff and/or landing aircraft designation) VC-25 (VIP and Cargo [Transport] mission designations) UH-60 (Utility mission designation and Helicopter aircraft designation)

8 MILITARY AVIATION RATING SCHEDULE RATINGS Determine the appropriate flat extra required apply the higher designation rating: Aircraft Flown: Rating ADB WP Mission/Aircraft Designations A, B, F, M, O and S Pilots and flight crew, including student pilots $7.50 No No Instructors $2.50 No No Reserve or National Guard pilots and crew members age 30 or over, not on extended duty, engaged in full time permanent civilian occupation and flying < 125 hours/year Standard No No Mission/Aircraft Designations C, E, H, K, P, T, U and V Pilots, instructors and flight crew Standard Yes Yes Student pilots Standard No No Any Other Mission/Aircraft Designations Contact Underwriting For example, for pilots of: F-22 (Fighter): Flat extra $7.50 for F Mission Designations C-5 (Cargo [Transport]): No flat extra required for C Mission Designations MV-22 (Multi-Mission Vertical takeoff and/or landing): Flat extra $7.50 for M Mission Designation and no flat extra for V Aircraft Designation. Apply the $7.50 flat extra. VC-25 (VIP Cargo [Transport]): No flat extra required for either the V and C Mission Designations UH-60 (Utility Helicopter): No flat extra required for either the U Mission Designation and the H Aircraft Designation Apply normal aviation guidelines for those pilots and crew members with no flat extra for military aviation.