double entry submission - Pilot Life Cover, Life cover for pilots, Life Assurance, Accident Insurance Flying Instructor Russ Stein. Life cover for skydivers. Skydiving life cover. Life assurance for skydivers. Skydiving life assurance.

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Title

First Name *

Surname *

Address *

Postal Town *

Postcode *

Email *

Contact number *

Your date of birth? *

are you a smoker?

If you have smoked tobacco or used nicotine replacement products within the last 12 months then insurers will deem you a smoker.

Aircraft you fly: Tick all that apply.

Commercial Aircraft: fixed wing
Commercial Aircraft: rotary wing
General aviation fixed wing aircraft
Integrated, MPL or Modular commercial pilot training
Microlight aircraft: fixed and flexwing
Paragliders, Paramotors, Hang Gliders
Gliders: powered & unpowered
Helicopters, Autogyros and Gyrocopters
Military, test & display flying
Other types incl: Ballooning, SSDR
Parachuting

Year you started to fly *

Commercial – approx total hours experience *

Commercial – approx hours flown in the last 12 months *

Commercial – estimated hours for the next 12 months *

Your fixed wing flying

Scheduled or Holiday Charter type routes
Corporate Bizjet/Private Charter flights
Other

other fixed wing flying details

We can usually secure highly competitive terms for Rotary pilots and crew. This includes S&R, Oil Operations, Ambulance, Police, Charter and Survey flights.

General aviation – approx total hours experience (P1+P/uT) *

General aviation – approx hours flown in the last 12 months *

General aviation – estimated hours for the next 12 months *

student pilot *

Types of A/C learning to Fly

Fixed wing
Rotary

Types of A/C learning to Fly (integrated/modular)

Integrated
Modular
Multi-crew pilots license

Training Provider

Other Training Provider

Commencement date if know

Approx total course fees

Microlight types flown *

Fixed Wing
Flexwing
Both

Microlight – approx total hours experience (P1+P/uT) *

Microlight – approx hours flown in the last 12 months *

Microlight – estimated hours for the next 12 months *

student pilot *

BHPA member *

Type Flown: Tick all that apply *

Paragliders
Paramotors
Hang Gliders

Paragliders – approx total hours experience *

Paragliders – estimated hours for the next 12 months *

Paragliders – approx hours flown in the last 12 months *

Paramotors – approx total hours experience *

Paramotors – estimated hours for the next 12 months *

Paramotors – approx hours flown in the last 12 months *

Hang Gliders – approx total hours experience *

Hang Gliders – approx hours flown in the last 12 months *

Hang Glider – estimated hours for the next 12 months *

student pilot *

Glider types flown: Tick all that apply

Powered
Unpowered
Self Sustaining Gliders

Powered gliders – approx total hours experience (P1+P/uT) *

Powered gliders – approx hours flown in the last 12 months *

Powered gliders – estimated hours for the next 12 months *

Unpowered gliders – approx total hours experience (P1+P/uT) *

Unpowered gliders – approx hours flown in last 12 months *

Unpowered glider – approx hours for the next 12 months *

Self sustaining gliders – approx total hours experience (P1+P/uT) *

Self sustaining gliders – approx hours flown in the last 12 months *

Self sustaining gliders – estimated hours for the next 12 months *

student pilot *

Type Rotary Flown: Tick all that apply. *

Helicopters
Autogyros
Gyrocopters

Rotary – approx total hours experience (P1+P/uT) *

Rotary – approx hours flown in the last 12 months *

Rotary – estimated hours for the next 12 months *

student pilot *

Types Flown *

Military – approx total hours experience *

Military – approx hours flown in the last 12 months *

Military – estimated hours for the next 12 months *

Types Flown *

Others – approx total hours experience *

Others – estimated hours for the next 12 months *

Others – approx hours flown in the last 12 months *

Year you started jumping *

Parachuting – total number of jumps to date *

Parachuting – expected number of jumps in the next 12 months *

Ratings (current)

IR(R)
IR
Night
MEP
Instructor/Examiner
Aeros (AOPA certificate or EASA endorsement)

Do you fly aerobatics or take part in competitions?

Please provide brief details competition

In addition to your flight training, do you also intend flying extra hours recreationally too?

Any other relevant or additional information?

Please provide with brief details

Do you require joint cover?

Additional policy holder's title

Additional policy name

Additional policy holder's date of birth

female/male

female
male

Are they a smoker?

Do they fly with you as a passenger?

I'm interested in

Life Insurance
Critical Illness
Combined Life & Critical Illness
Loss of Licence Cover
Income Protection
Not sure – I wish to discuss, please contact me on the number above

I'm interested in (integrated and modular cadet pilots only)

Life & Serious Illness Insurance products for cadet pilots
Training Expenses Insurance for cadet pilots
Long term travel insurance to include overseas flight training
I wish to discuss my options, please contact me on the number above

Life Insurance Amount

Term in Years Life

Life Insurance Basis

Level
Index Linked
Decreasing

Critical Illness Cover Amount

Term in Years Critical

Critical Illness Cover Basis

Level
Index Linked
Decreasing

Combined Insurance Amount

Term in Years Combined

Combined Cover Type

Level
Index Linked
Decreasing

Reason for Cover

Family Protection
Family and Mortgage Protection
Mortgage Protection
Business Related
Other

Annual income from flying duties

Given the highly bespoke nature of our service we would recommend a brief conversation – are you OK if we call you?

Where did you hear about SPI

Google
Magazine Ad
Recommendation from existing SPI client
Returning SPI client
Social Media
Aviation Portal
Trade Show
Recommendation from your flight school
Wings Alliance