ACORD 341 Instructions


Section Name Field Name Field and/or Section Description
TITLE ACORD 341 (2009/06) Pilot Experience Change Request The title of the form. ACORD 341, Pilot Experience Change Request, is used to indicate changes to a pilot and their experience with different types of aircraft. This form is used in conjunction with ACORD 340, Aircraft Change Request and ACORD 337, Airport and FBO Liability Change Request.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer’sidentification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Date (MM/DD/YYYY) Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Agency Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
IDENTIFICATION SECTION Effective Date of Change Enter date: The date on which the change should take effect.
IDENTIFICATION SECTION Effective Time of Change Enter time: The effective time of the policy change.
IDENTIFICATION SECTION Effective Time AM Check the box (if applicable): Indicates the effective time of the policy change is in the morning (AM).
IDENTIFICATION SECTION Effective Time PM Check the box (if applicable): Indicates the effective time of the policy change is in the afternoon or evening (PM).
IDENTIFICATION SECTION Named Insured Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION Carrier Enter text: The insurer’s full legal company name(s) as found in thefile copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer’s group name or trade name.
IDENTIFICATION SECTION NAIC Code Enter code: The identification code assigned to the insurer by the NAIC.
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Section Name Field Name Field and/or Section Description
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Pilot Number Enter number: The producer assigned number for the pilot.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Pilot’s Name Enter text: The full name of the pilot.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Street Enter text: The pilot’s mailing address line one.
PILOT INFORMATION Street (continued) Enter text: The pilot’s mailing address line two.
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Section Name Field Name Field and/or Section Description
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION City Enter text: The pilot’s mailing address city name.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION State Enter code: The pilot’s mailing address state or province code.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Zip Enter code: The pilot’s mailing address postal code.
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Section Name Field Name Field and/or Section Description
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Home Phone Enter number: The pilot’s primary phone number. As used here, this is the home phone number.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Business Phone Enter number: The pilot’s secondary phone number. As used here, this is the business phone number.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Fax No. (A/C, No, Ext) Enter number: The primary fax number of the pilot.
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Section Name Field Name Field and/or Section Description
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION E-Mail Address Enter text: The pilot’s primary e-mail address.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Date of Birth Enter date: The birth date of the pilot.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Marital Status Enter code: The marital status of the pilot. Examples are: S – Single; M – Married; D -Divorced; P – Separated; W – Widowed, C – Domestic Partner (unmarried), V – Civil Union, U – Unknown, O – Other
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Section Name Field Name Field and/or Section Description
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION AOPA Number Enter identifier: The pilot’s Aircraft Owners and Pilots Association (AOPA) number.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION EAA Number Enter identifier: The pilot’s Experimental Aircraft Association (EAA) number.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Airman’s Certificate Number Enter identifier: The pilot’s Airman’s Certificate Number.
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Section Name Field Name Field and/or Section Description
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Current Employer Enter text: The name of the pilot’s current employer.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Hire Date Enter date: The date the pilot was hired by their current employer.
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Occupation Enter text: The pilot’s occupation.
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Section Name Field Name Field and/or Section Description
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Registration Numbers of Assigned Aircraft Enter identifier: The registration number of the aircraft (a.k.a. tail number).
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Registration Numbers of Assigned Aircraft Enter identifier: The registration number of the aircraft (a.k.a. tail number).
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Registration Numbers of Assigned Aircraft Enter identifier: The registration number of the aircraft (a.k.a. tail number).
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Section Name Field Name Field and/or Section Description
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Registration Numbers of Assigned Aircraft Enter identifier: The registration number of the aircraft (a.k.a. tail number).
PILOT INFORMATION Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
PILOT INFORMATION Registration Numbers of Assigned Aircraft Enter identifier: The registration number of the aircraft (a.k.a. tail number).
CERTIFICATIONS AND RATINGS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other 1 Description Enter text: The description of the type of pilot rating.
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Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other 2 Description Enter text: The description of the type of pilot rating.
CERTIFICATIONS AND RATINGS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other 3 Description Enter text: The description of the type of pilot rating.
CERTIFICATIONS AND RATINGS Single Engine Land Student Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Rotor Wing Student Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Glider Student Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Lighter Than Air Student Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Other Student Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Student Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Student Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Single Engine Land Recreational Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Glider Recreational Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Recreational Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Other Recreational Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Recreational Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Single Engine Land Sport Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Single Engine Sea Sport Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Rotor Wing Sport Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Glider Sport Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Other Sport Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Sport Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Sport Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Single Engine Land Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Multi-Engine Land Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Instrument Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Single Engine Sea Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Multi-Engine Sea Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Rotor Wing Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Glider Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Lighter Than Air Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Other Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Private Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Single Engine Land Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Multi-Engine Land Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Instrument Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Single Engine Sea Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Multi-Engine Sea Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Rotor Wing Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Glider Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Lighter Than Air Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Other Commercial Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Single Engine ATP Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Multi-Engine ATP Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Instrument ATP Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Single Engine Sea ATP Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Multi-Engine Sea ATP Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Rotor Wing ATP Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Lighter Than Air ATP Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other ATP Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Other ATP Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other ATP Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Single Engine Land Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Multi-Engine Land Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Instrument Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Single Engine Sea Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Multi-Engine Sea Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Rotor Wing Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Glider Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Lighter Than Air Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
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Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Other Instructor Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Type Enter text: The type of certification.
CERTIFICATIONS AND RATINGS Single Engine Land Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Multi-Engine Land Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Instrument Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Single Engine Sea Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Multi-Engine Sea Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Rotor Wing Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Glider Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Lighter Than Air Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
ACORD 341 (2009/06) 35 of 53

Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Other Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Are you and A&P Mechanic? Enter Y for a “Yes†response. Input N for “No†response. Indicates the response to the question, “Are you an A&P mechanic”.
CERTIFICATIONS AND RATINGS Date obtained Enter date: The date the airframe and power plant mechanic certification was obtained.
CERTIFICATIONS AND RATINGS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Are you an Inspection Authority? Enter Y for a “Yes†response. Input N for “No†response. Indicates the response to the question, “Are you an inspection authority (I/A)”.
Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Date obtained Enter date: The date the inspection authority (I/A) certification was obtained.
CERTIFICATIONS AND RATINGS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Medical Date Enter date: The date the medical certification was obtained.
CERTIFICATIONS AND RATINGS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Class I Check the box (if applicable): Indicates a Class I medical certification.
CERTIFICATIONS AND RATINGS Class II Check the box (if applicable): Indicates a Class II medical certification.
CERTIFICATIONS AND RATINGS Class III Check the box (if applicable): Indicates a Class III medical certification.
ACORD 341 (2009/06) 37 of 53

Section Name Field Name Field and/or Section Description
CERTIFICATIONS AND RATINGS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
CERTIFICATIONS AND RATINGS Flight Review Date Enter date: The date of the flight review.
CERTIFICATIONS AND RATINGS Flight Review Aircraft Type Enter text: The description of the type of aircraft used for the flight review.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Total Hours Enter number: The total number of hours the pilot has logged.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Pilot in Command Enter number: The number of hours the pilot has logged as a pilot in command.
ACORD 341 (2009/06) 38 of 53

Section Name Field Name Field and/or Section Description
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Second in Command Enter number: The number of hours the pilot has logged as second in command.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Multi-Engine Land Enter number: The number of hours the pilot has logged in multi-engine land aircraft.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Retractable Gear Enter number: The number of hours the pilot has logged in aircraft with retractable gear.
ACORD 341 (2009/06) 39 of 53

Section Name Field Name Field and/or Section Description
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Conventional Gear Enter number: The number of hours the pilot has logged in aircraft with conventional gear.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Total Seaplane Enter number: The total number of hours the pilot has logged in seaplanes.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Multi-Engine Seaplane Enter number: The number of hours the pilot has logged in multi-engine seaplanes.
ACORD 341 (2009/06) 40 of 53

Section Name Field Name Field and/or Section Description
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Total amphibious Enter number: The total number of hours the pilot has logged in amphibious aircraft.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Rotor Wing Enter number: The number of hours the pilot has logged in rotor wing aircraft.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Turbine Rotor Wing Enter number: The number of hours the pilot has logged in turbine rotor wing aircraft.
ACORD 341 (2009/06) 41 of 53

Section Name Field Name Field and/or Section Description
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Total Agriculture Enter number: The total number of hours the pilot has logged in agriculture aircraft.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Turbine Agriculture Enter number: The number of hours the pilot has logged in turbine agriculture aircraft.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Rotor Wing AG Enter number: The number of hours the pilot has logged in rotor wing agriculture aircraft.
ACORD 341 (2009/06) 42 of 53

Section Name Field Name Field and/or Section Description
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Turbine Rotor Wing AG Enter number: The number of hours the pilot has logged in turbine rotor wing agriculture aircraft.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Alaska Enter number: The number of hours the pilot has logged in Alaska.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Instrument Enter number: The number of hours the pilot has logged with instruments.
ACORD 341 (2009/06) 43 of 53

Section Name Field Name Field and/or Section Description
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Total Turbine Enter number: The total number of hours the pilot has logged in turbine aircraft.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Turbo Jet Enter number: The number of hours the pilot has logged in turbo jets.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Turbo Prop Enter number: The number of hours the pilot has logged in turbo prop aircraft.
ACORD 341 (2009/06) 44 of 53

Section Name Field Name Field and/or Section Description
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS SE Turbo Prop Enter number: The number of hours the pilot has logged in single engine turbo prop aircraft.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Last 90 Days Enter number: The number of hours the pilot has logged in the last 90 days.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Last 12 Months Enter number: The number of hours the pilot has logged in the last 12 months.
ACORD 341 (2009/06) 45 of 53

Section Name Field Name Field and/or Section Description
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Other Enter text: The description of the type of hours logged by the pilot.
LOGGED HOURS Other Hours Enter number: The number of hours logged by the pilot.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Other Enter text: The description of the type of hours logged by the pilot.
LOGGED HOURS Other Hours Enter number: The number of hours logged by the pilot.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Other Enter text: The description of the type of hours logged by the pilot.
LOGGED HOURS Other Hours Enter number: The number of hours logged by the pilot.
ACORD 341 (2009/06) 46 of 53

Section Name Field Name Field and/or Section Description
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Other Enter text: The description of the type of hours logged by the pilot.
LOGGED HOURS Other Hours Enter number: The number of hours logged by the pilot.
LOGGED HOURS Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
LOGGED HOURS Other Enter text: The description of the type of hours logged by the pilot.
LOGGED HOURS Other Hours Enter number: The number of hours logged by the pilot.
AIRCRAFT APPROVAL Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
AIRCRAFT APPROVAL Make Enter text: The manufacturer of the aircraft.
AIRCRAFT APPROVAL Model Enter text: The model of the aircraft.
ACORD 341 (2009/06) 47 of 53

Section Name Field Name Field and/or Section Description
AIRCRAFT APPROVAL Total Enter number: The total number of aircraft flight hours.
AIRCRAFT APPROVAL Last 90 Days Enter number: The number of aircraft flight hours in the last 90 days.
AIRCRAFT APPROVAL Last 12 Months Enter number: The number of aircraft flight hours in the last 12 months.
AIRCRAFT APPROVAL Annual Recurrent Training? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot receives annual recurrent training in this type of aircraft.
AIRCRAFT APPROVAL Current FSI Card? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot holds a current Flight Safety International (FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL Training Facility Enter code: Indicates the training facility used for this aircraft type (i.e. AMERF – American Flyers, FAAWI – FAA Wings, PINSCI – Professional Instrument Courses Inc., SIMFI -Simuflight Inc., OT – Other Description).
AIRCRAFT APPROVAL Training Date Enter date: The training date for this type of aircraft.
AIRCRAFT APPROVAL Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
AIRCRAFT APPROVAL Make Enter text: The manufacturer of the aircraft.
AIRCRAFT APPROVAL Model Enter text: The model of the aircraft.
AIRCRAFT APPROVAL Total Enter number: The total number of aircraft flight hours.
AIRCRAFT APPROVAL Last 90 Days Enter number: The number of aircraft flight hours in the last 90 days.
AIRCRAFT APPROVAL Last 12 Months Enter number: The number of aircraft flight hours in the last 12 months.
AIRCRAFT APPROVAL Annual Recurrent Training? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot receives annual recurrent training in this type of aircraft.
AIRCRAFT APPROVAL Current FSI Card? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot holds a current Flight Safety International (FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL Training Facility Enter code: Indicates the training facility used for this aircraft type (i.e. AMERF – American Flyers, FAAWI – FAA Wings, PINSCI – Professional Instrument Courses Inc., SIMFI -Simuflight Inc., OT – Other Description).
AIRCRAFT APPROVAL Training Date Enter date: The training date for this type of aircraft.
ACORD 341 (2009/06) 48 of 53

Section Name Field Name Field and/or Section Description
AIRCRAFT APPROVAL Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
AIRCRAFT APPROVAL Make Enter text: The manufacturer of the aircraft.
AIRCRAFT APPROVAL Model Enter text: The model of the aircraft.
AIRCRAFT APPROVAL Total Enter number: The total number of aircraft flight hours.
AIRCRAFT APPROVAL Last 90 Days Enter number: The number of aircraft flight hours in the last 90 days.
AIRCRAFT APPROVAL Last 12 Months Enter number: The number of aircraft flight hours in the last 12 months.
AIRCRAFT APPROVAL Annual Recurrent Training? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot receives annual recurrent training in this type of aircraft.
AIRCRAFT APPROVAL Current FSI Card? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot holds a current Flight Safety International (FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL Training Facility Enter code: Indicates the training facility used for this aircraft type (i.e. AMERF – American Flyers, FAAWI – FAA Wings, PINSCI – Professional Instrument Courses Inc., SIMFI -Simuflight Inc., OT – Other Description).
AIRCRAFT APPROVAL Training Date Enter date: The training date for this type of aircraft.
AIRCRAFT APPROVAL Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
AIRCRAFT APPROVAL Make Enter text: The manufacturer of the aircraft.
AIRCRAFT APPROVAL Model Enter text: The model of the aircraft.
AIRCRAFT APPROVAL Total Enter number: The total number of aircraft flight hours.
ACORD 341 (2009/06) 49 of 53

Section Name Field Name Field and/or Section Description
AIRCRAFT APPROVAL Last 90 Days Enter number: The number of aircraft flight hours in the last 90 days.
AIRCRAFT APPROVAL Last 12 Months Enter number: The number of aircraft flight hours in the last 12 months.
AIRCRAFT APPROVAL Annual Recurrent Training? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot receives annual recurrent training in this type of aircraft.
AIRCRAFT APPROVAL Current FSI Card? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot holds a current Flight Safety International (FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL Training Facility Enter code: Indicates the training facility used for this aircraft type (i.e. AMERF – American Flyers, FAAWI – FAA Wings, PINSCI – Professional Instrument Courses Inc., SIMFI -Simuflight Inc., OT – Other Description).
AIRCRAFT APPROVAL Training Date Enter date: The training date for this type of aircraft.
AIRCRAFT APPROVAL Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
AIRCRAFT APPROVAL Make Enter text: The manufacturer of the aircraft.
AIRCRAFT APPROVAL Model Enter text: The model of the aircraft.
AIRCRAFT APPROVAL Total Enter number: The total number of aircraft flight hours.
AIRCRAFT APPROVAL Last 90 Days Enter number: The number of aircraft flight hours in the last 90 days.
AIRCRAFT APPROVAL Last 12 Months Enter number: The number of aircraft flight hours in the last 12 months.
AIRCRAFT APPROVAL Annual Recurrent Training? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot receives annual recurrent training in this type of aircraft.
AIRCRAFT APPROVAL Current FSI Card? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot holds a current Flight Safety International (FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL Training Facility Enter code: Indicates the training facility used for this aircraft type (i.e. AMERF – American Flyers, FAAWI – FAA Wings, PINSCI – Professional Instrument Courses Inc., SIMFI -Simuflight Inc., OT – Other Description).
AIRCRAFT APPROVAL Training Date Enter date: The training date for this type of aircraft.
ACORD 341 (2009/06) 50 of 53

Section Name Field Name Field and/or Section Description
AIRCRAFT APPROVAL Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
AIRCRAFT APPROVAL Make Enter text: The manufacturer of the aircraft.
AIRCRAFT APPROVAL Model Enter text: The model of the aircraft.
AIRCRAFT APPROVAL Total Enter number: The total number of aircraft flight hours.
AIRCRAFT APPROVAL Last 90 Days Enter number: The number of aircraft flight hours in the last 90 days.
AIRCRAFT APPROVAL Last 12 Months Enter number: The number of aircraft flight hours in the last 12 months.
AIRCRAFT APPROVAL Annual Recurrent Training? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot receives annual recurrent training in this type of aircraft.
AIRCRAFT APPROVAL Current FSI Card? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot holds a current Flight Safety International (FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL Training Facility Enter code: Indicates the training facility used for this aircraft type (i.e. AMERF – American Flyers, FAAWI – FAA Wings, PINSCI – Professional Instrument Courses Inc., SIMFI -Simuflight Inc., OT – Other Description).
AIRCRAFT APPROVAL Training Date Enter date: The training date for this type of aircraft.
AIRCRAFT APPROVAL Type of Change Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN).
AIRCRAFT APPROVAL Make Enter text: The manufacturer of the aircraft.
AIRCRAFT APPROVAL Model Enter text: The model of the aircraft.
AIRCRAFT APPROVAL Total Enter number: The total number of aircraft flight hours.
ACORD 341 (2009/06) 51 of 53

Section Name Field Name Field and/or Section Description
AIRCRAFT APPROVAL Last 90 Days Enter number: The number of aircraft flight hours in the last 90 days.
AIRCRAFT APPROVAL Last 12 Months Enter number: The number of aircraft flight hours in the last 12 months.
AIRCRAFT APPROVAL Annual Recurrent Training? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot receives annual recurrent training in this type of aircraft.
AIRCRAFT APPROVAL Current FSI Card? Enter Y for a “Yes†response. Input N for “No†response. Indicates if the pilot holds a current Flight Safety International (FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL Training Facility Enter code: Indicates the training facility used for this aircraft type (i.e. AMERF – American Flyers, FAAWI – FAA Wings, PINSCI – Professional Instrument Courses Inc., SIMFI -Simuflight Inc., OT – Other Description).
AIRCRAFT APPROVAL Training Date Enter date: The training date for this type of aircraft.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage).
GENERAL INFORMATION 1. Do you participate in the FAA pilot proficiency award program? If “yes†complete the following and attach certificate: Enter Y for a “Yes†response. Input N for “No†response. Indicates the response to the question, “Do you participate in FAA Pilot Proficiency Award Program?”.
GENERAL INFORMATION Highest Number Completed Enter code: Indicates the FAA Pilot Proficiency Award Program highest phase completed. Enter the phase number 1 through 20 or N/A for not applicable.
GENERAL INFORMATION Aircraft Used Enter text: The aircraft used in the FAA Pilot Proficiency Award Program.
GENERAL INFORMATION Completion Date Enter date: The date the FAA Pilot Proficiency Award Program was completed.
GENERAL INFORMATION 2. List refresher courses including dates of the last course attended: Enter text: The description of the educational course.
GENERAL INFORMATION Date Enter date: The date the educational course was attended.
GENERAL INFORMATION Course Name Enter text: The description of the educational course.
GENERAL INFORMATION Date Enter date: The date the educational course was attended.
GENERAL INFORMATION Course Name Enter text: The description of the educational course.
GENERAL INFORMATION Date Enter date: The date the educational course was attended.
GENERAL INFORMATION Course Name Enter text: The description of the educational course.
GENERAL INFORMATION Date Enter date: The date the educational course was attended.
GENERAL INFORMATION Course Name Enter text: The description of the educational course.
GENERAL INFORMATION Date Enter date: The date the educational course was attended.
GENERAL INFORMATION Course Name Enter text: The description of the educational course.
GENERAL INFORMATION Date Enter date: The date the educational course was attended.
GENERAL INFORMATION Course Name Enter text: The description of the educational course.
GENERAL INFORMATION Date Enter date: The date the educational course was attended.
ACORD 341 (2009/06) 52 of 53

Section Name Field Name Field and/or Section Description
GENERAL INFORMATION Course Name Enter text: The description of the educational course.
GENERAL INFORMATION Date Enter date: The date the educational course was attended.
GENERAL INFORMATION Course Name Enter text: The description of the educational course.
GENERAL INFORMATION Date Enter date: The date the educational course was attended.
GENERAL INFORMATION Course Name Enter text: The description of the educational course.
GENERAL INFORMATION Date Enter date: The date the educational course was attended.
GENERAL INFORMATION 3. Do you have any physical impairments, limitations, or waivers on medical certificate? Enter Y for a “Yes†response. Input N for “No†response. Indicates the response to the question, “Any physical impairments or limitations or waivers on Medical Certificate?”.
GENERAL INFORMATION Explain Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation.
GENERAL INFORMATION 4. Have you ever had an aircraft accident or incident or been penalized for an far violation? Enter Y for a “Yes†response. Input N for “No†response. Indicates the response to the question, “Have you ever had an aircraft accident or incident or been penalized for a FAR violation?”.
GENERAL INFORMATION Explain Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation.
GENERAL INFORMATION 5. Has any insurance company or underwriter cancelled, or refused to renew any insurance on your behalf? (not applicable in MO) Enter Y for a “Yes†response. Input N for “No†response. Indicates the response to the question, “Has any insurance company or underwriter cancelled, or refused to renew any insurance on your behalf?”.
GENERAL INFORMATION Explain Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation.
GENERAL INFORMATION 6. Have you ever been convicted of driving a motor vehicle under the influence of alcohol or narcotics, or of reckless driving? Enter Y for a “Yes†response. Input N for “No†response. Indicates the response to the question, “Have you ever been convicted of driving a motor vehicle under the influence of alcohol or narcotics, or of reckless driving?”.
GENERAL INFORMATION Explain Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation.
GENERAL INFORMATION 7. Any drivers license been suspended/revoked? Enter Y for a “Yes†response. Input N for “No†response. Indicates the response to the question, “Any drivers license been suspended or revoked?”.
GENERAL INFORMATION Explain Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation.
Section Name Field Name Field and/or Section Description
GENERAL INFORMATION 8. Have you ever been convicted of or are you under indictment in a legal action involving drugs or narcotics? Enter Y for a “Yes†response. Input N for “No†response. Indicates the response to the question, “Have you ever been convicted of or are you under indictment in a legal action involving drugs or narcotics?”.
GENERAL INFORMATION Explain Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation.
SIGNATURES Pilot’s Signature Sign here: Accommodates the signature of the pilot.
SIGNATURES Date Enter date: The date the form was signed by the pilot.
REMARKS Remarks Enter text: The remarks associated with a policy change. Attach ACORD 101, Additional Remarks Schedule, if more space is required.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).