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Are you concerned about getting a low-premium, full-coverage life insurance quote as an aviator? At Aviation Life Insurance and Life Insurance For Pilots, we take the hassle out of getting a clear, understandable quote for all your aviation activities. You will appreciate the individual attention you'll get at Life Insurance For Pilots.

Our quote process takes into account your needs for life insurance as a pilot. You and your family's needs and desires are also important to us. With accurate and current information, Aviation Life Insurance will provide you with your individualized life insurance quote. The lowest premium available and no exclusion for aviation.

Please complete the following information.

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

If you would like a term life insurance quote immediately please call 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:

   

 

  
 


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

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