Claim Report

Policy Holder *

Policy Number *

Policy Effective Date *

Date of Incident*

Time of Incident *

N-Number Involved

Location of Incident

Location of Aircraft Now

Pilot In Command at Time of Incident

Passengers in Aircraft at the time of Incident

Tail Number, Make and Model of Aircraft Involved

Ownership Details of Aircraft

Ownership Contact Info (if available)

Pilot in Command at the Time of Incident

Location of Incident

Location of the Aircraft Now

UAS Serial Number

Pilot In Command at Time of the Incident

Location of Incident

Location of UAS Now

Describe Damage to the UAS

Hangar Address and Hangar Number

Description of the Incident *

Describe Damage to the Aircraft and/or any Passenger Injuries

Describe any Bodily Injury or Property Damage (Third Party Damage)

Best Point Of Contact *

Phone Number *

Email Address *

Best Time to Contact

Which type of claim are you submitting?