Renewal Form

Disclaimer: Any changes requested on this website are NOT official until you receive written confirmation from Regal Aviation Insurance.

*required fields

*Name of person entering renewal info:

*Email address of person entering renewal info:

*Insured ID # (found on renewal form we sent you):

Client Information

Compared to the Renewal Summary we sent you,

Has any information in the Client Information section changed?

Yes No

Named Insured Changes:
Address Changes:
City Changes:
State Changes:
Zip Code Changes:
Phone Changes:
Cell Phone Changes:
Fax Changes:
Email Changes:

Insured Aircraft Information

Compared to the Renewal Summary we sent you,

Has any information in the Insured Aircraft Information Section changed?

Yes No

Aditional Interestes

Compared to the renewal summary we sent you,

Has the additional interest information changed for this year?

Yes No

Would you like to remove the additional interest from the policy?

Yes No

Pilot Information

Please review the Pilot Information in the Renewal Summary we sent you.

This contains the hours you told us last year when we renewed your policy. It also shows a list of the pilots on your policy.

Please fill out updates for all pilots listed on the renewal information, or any pilots you might want to add .

Number of Pilots:

Pilot #1
*Pilot Name:
Occupation:
*Certs/Ratings (check all that apply):	Student Sport Pilot Private Commercial ATP Rotor Wing Glider Instrument Rating Multi Engine Rating Single Engine Sea Rating Multi Engine Sea Rating CFI CFII MEI MEII
*Date of Medical:
*Date of Flight Review:
*Total Hours:
*Make and Model Hours:
*Last 12 Months:
Tail Wheel Hours:
Retractable Gear Hours:

Turbine Hours:

AOPA#:
EAA#:

Supplemental Pilot Information

*Have any pilots on your policy participated in any recurrent training in the last 12 months?

Yes No

*Have any pilots on your policy had ANY citations, convictions, or suspensions for FAR violations, use of drugs, or drunk driving?

Yes No

*Have any pilots on your policy had ANY Aviation insurance claims, losses, accidents, incidents, or violations?

Yes No

Notes Section

Notes:

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