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Looking for a low cost aviation life insurance quote? Have you ever been disappointed because, after going through a less than pleasurable application process, the life insurance policy you finally received didn't provide the coverage or guarantees at the premium you expected? If so, you will appreciate the individual attention you will receive at Life Insurance For Pilots.

We know you are a unique individual with your own aviation, medical and financial history. We know you and your family's needs are personal and important. That is exactly how we work, one unique individual at a time. With accurate and current information we will be able to provide you with a full coverage for pilots life insurance quote at the lowest premiums available.

Please complete the following information so we may begin working for you.

Coverage may not be available in all jurisdictions. CA license #540705068.

For an immediate aviation life insurance quote please telephone us at 1-800-624-7705 ext. 19.

Please read our privacy statement.

If you prefer not to fill out this information please email or telephone us.

Please read our privacy statement.

All fields marked with a * are required.

PILOT INFORMATION

Pilot status:
Number of hours flown as pilot:
(please enter whole numbers only)
Hours flown in past 12 months:

Type of aircraft flown in past year:

(note: to select more than one box:
For Windows users: Use Ctrl + click
For MAC users: Use Command + click)
Do you intend to fly outside the United States: Yes   No

POLICY INFORMATION

Policy amount requested:
(ex. 500000)		 $
Term/plan requested:
other (please specify):

PERSONAL INFORMATION

* First Name / MI / Last Name:
State of Residence:
* Telephone:
(Please provide at least one.)
Home
Work
Cell
Best time to call:
* Email:
* Date of Birth:
(dd/mm/yyyy)		 / /
* Sex: Male   Female
Tobacco or nicotine usage:
Are you currently taking any prescription medications: Yes   No
Height (in shoes): ft. in.
Weight (without shoes): lbs.
Have you, or your natural parents or siblings, had an occurrence of cardiovascular disease or cancer before the age of 60?: Yes   No
Do you or do you expect to participate in motor vehicle racing, scuba or sky diving?: Yes   No
Additional comments or information which you feel may affect the underwriting of your policy:

   

 

  
 


Life Insurance For Pilots
Portland, OR 97202
888.465.5228  |  Fax: 503.233.0084
jim@lifeinsuranceforpilots.com

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