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Drone Insurance Application Form

Collects the applicant's details and the drone's characteristics to evaluate and process an insurance policy.

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Name

Nombre

Apellido

Phone number

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Date of birth

Occupation

Gender

Male Female Other

Make

Model

Serial number

Date of purchase

Current value ($)

Purpose of use

Personal Commercial Agricultural

Maximum altitude

Maximum flight distance

Does the drone have any modifications or aftermarket additions? (If so, please provide details)

Please select the coverage options you're interested in

Liability Physical damage Theft

Have you had any accidents or incidents with this drone in the past?

Yes No

Please provide details

Have you received any training or certification for operating drones?

Yes No

Please provide details

Are you aware of any regulations or restrictions on drone operations in your area?

Yes No

Please specify

Applicant certification

Date

Signature

Sign here

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