Sutton James - Renewal Questionnaire

Sutton James Incorportated Aviation Insurance Brokers

For Light Aircraft

If you are a NEW customer, please click here.

Name:

Address:

City:

State: Zip:

Aircraft (Year, Make, Model)
Total # of seats
Please list any lienholders
Aircraft based at (Airport name)
Aircraft	Hangared Tied down

Coverages & Limits
Please let us know what limits you would like for next year:

Aircraft Hull Value:

Liability Limits:

Pilot Information

Name
Date of Birth
Cert. & Ratings
Total Logged Hours
Total Hours in this Make & Model
Hours in this Make & Model Last Year
Total Hours Last Year - Any Aircraft

1. Please describe, including dates, any recurrent pilot training, Instrument Competency Checks, WINGS Program, etc., completed by each pilot.

2. Dates of latest:: Medical ( Class ); BFR

3. Describe in detail any aviation losses or incidents, FAR violation, license limitations, DUI or felony convictions for each pilot.

4. Has any insurer canceled, declined, or refused to renew? If so, please describe.

Please select your broker from the following list:

        Jon Doolittle, Jr.

        James Buffington

        Shara Buffington

        Airika Robb

        Caitlyn Jones-Henry

        Richard Kenney

        I do not know