UAV Operator Insurance Proposal

  • GENERAL INFO
  • *PLEASE NOTE INSURERS DO NOT COVER ANY RECREATIONAL USE.

  • COVERAGES REQUIRED

  • Third Party Liability
    Covers liability to third parties for third party loss/damage, consequential of UAV failure.
  • Physical loss & damage to UAV
    Covers physical loss or damage to UAV (airframe, payload, launch station and/or GCS).
    **Please provide values on the schedule below to indicate requested hull coverage**
  • YearMakeModelValueRegistration NumberWeightEstimated Annual Flight Hours 
    Add a new row
  • EquipmentValue per unitNumber of UnitsTotal Value 
    Add a new row

  • OPERATIONS
  • General Liability Coverage
    Covers liability to third parties for third party loss/damage, not consequential of UAV failure, but on site and in relation to the Insured’s UAV activities.
  • Pilot Information
  • NameDate of BirthLicense #Type of FAA CertificationTotal time on UAVUAV time past 12 monthsUAV time on model to be insuredAccident/Incidents in the past 5 years 
    Add a new row
  • Personal Accident Coverage
    Provides benefits in accordance with the following:
    • Death
    • Loss of one limb
    • Loss of two or more limbs
    • Loss of sight of one eye
    • Loss of sight of both eyes
    • Loss of sight of one eye and loss of one limb

    Up to a maximum of $250,000 per person, or capped at 5 times annual salary if less.
  • Number of Pilots to be coveredSalaries of pilots to be coveredSum insured required 
  • Additional Coverages:
    (Contractual Insurance Requirements)
    CHECK ALL THAT APPLY
  • CarrierLimitsPremiumLosses 
    Add a new row
  • DECLARATION
    NOTICE TO APPLICANTS: THIS APPLICATION MUST BE COMPLETED IN FULL AS THE QUOTE WILL BE BASED SOLELY ON THE INFORMATION PROVIDED, ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON, FILES AN APPLICATION FOR INSURANCE CONTAINING FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME BY SIGNING THIS APPLICATION, THE SIGNOR WARRANTS THAT TO THEIR BEST KNOWLEDGE ALL INFORMATION GIVENS IS TRUE AND ACCURATE.

    I hereby declare that to the best of my knowledge and belief, the particulars and answers herein are true and correct and that I have not knowingly withheld any information which would influence the decision of the underwriters in regard to this proposal.

    It is understood and agreed that this proposal shall form the basis of the contract should a policy be issued.

    This application does not commit the Insurer to any liability nor has make the applicant liable for any premium unless the Insurer agrees in writing the coverage been bound. All details regarding qualifications shall be supported with relevant documentation.
  • NOTICE TO PRODUCERS: THE PRODUCER HEREBY WARRANTS THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE.
January 24th, 2017 by Intermarket Insurance Agency