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* 1. Gender

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* 2. Age

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* 3. Which pilot certificate(s) have you obtained (check all that apply)?

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* 4. What ratings have you obtained (check all that apply):

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* 5. Do you hold Type Ratings or LOAs

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* 6. Do you regularly participate in non-mandatory safety training (check all that apply)?

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* 7. What type of airplane (make and model) are you trying to insure?

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* 8. What (if any) Type Clubs do you belong to:

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* 9. Are you in a special insurance program through any of these groups

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* 10. Who is your Insurance Underwriter?

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* 11. At your last policy renewal, did you experience a change in premium for the LIABILITY component of your insurance?

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* 12. At your last policy renewal, did you experience a change in premium for the HULL component of your insurance?

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* 13. Did your Insurance Underwriter require changes to coverages or limits to obtain those rates (please list):

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* 14. Did your Insurance Underwriter impose any new requirements like additional training, or additional rated pilots (please list):

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* 15. With regards to your primary aircraft, please select the most appropriate category this aircraft falls into:

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* 16. Please select the type of Airworthiness Certificate for this aircraft

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* 17. Please check all features that apply to this aircraft:

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