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North Georgia Sport Planes


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Contact Info

Two insurance providers are available:

Ladd Gardner

Falcon Insurance Agency, Inc. or 866-647-4EAA (4322) M-F 8:00AM-5:00PM Central



The Avemco Team <>

Mail or fax to:
Avemco Insurance Company
411 Aviation Way
Frederick, MD  21701
Fax:  800-863-3338

411 Aviation Way
Frederick, Maryland 21701
1-800-638-8440 Fax: 1-800-863-3338

SUPPLEMENTAL APPLICATION FORM - (Amateur Built Experimental)
Name:__________________________ Address:_______________________________
City: ___________________ State: ____ Zip: _________ Home Phone:
Employer____________________ Occupation:_________ Work Phone:____________
Email: _______________________________ Date of Birth:     ___/___/___
Pilot Cert. #__________________________ Date of Last BFR:    ___/___/___
Medical Certificate: Date Issued ________________ Class:
Section A:
(To be completed by all applicants)

Aircraft Make and Model: __________________________Registration:
Date of last Condition Inspection: ___/___/___
Have any modifications or changes been made to the aircraft structure,
components or systems, other than those recommended by the kit/plan
manufacturer/supplier?  If YES, please describe:
Engine Make/Model/Horsepower:____________________________________________
Propeller Make/Model/Size: ________________________________________________
Have any modifications or changes been made to the aircraft engine or
propeller?  If YES, please describe:
Has the engine been installed in accordance with the kit/plans
manufacturer's recommendations?
If this is an automobile engine conversion is it a firewall forward
installation from the manufacturer?
Is the aircraft equipped for IFR in accordance with FAR section
Is the aircraft currently operating in Phase II of its operating
Proceed to Section "C" of this form If NO: Complete Section "B" and "C" of
this form

Section B:
(To be completed by applicants in Phase I of the aircraft operating

Has the aircraft been test flown? ____________________________Date:
Did you utilize the EAA's Technical Counselor Program?
If YES, name of Technical Counselor:
Have you participated in the EAA's Flight Advisor Program for this aircraft?
If YES, name of Flight
Will you be using a test pilot other than yourself? If YES, please provide
the following information:
Test pilot Name:_____________________ Address: ____________________________
City: ________________________ State/Province: ______________
License, Certificates, Ratings:
Total Hours: ____________________________________________________________

Total Tailwheel Hours: ____________________________________________________
Total Retract Gear Hours: _________________________________________________
Total Hours in this make/model of aircraft:
Has the Test Pilot participated in the EAA's Flight Advisor program for this
aircraft or is the Test Pilot an EAA Flight Advisor?
Has the Test Pilot within the past 90 days logged at least 5 hours as the
sole manipulator of the controls, including 3 take offs and landings in an
aircraft of the same make and model as the insured aircraft?

SUPPLEMENTAL APPLICATION FORM - (Amateur Built Experimental)
Section C:
(To be completed by all applicants)

Are you the sole owner of the aircraft?
Did any professional builder construct more than 20% of this aircraft?
Do you hold a Repairman Certificate for the aircraft?
How many hours of flight time has this aircraft accumulated?
How many hours of flight time has this engine and propeller combination
How many hours do you have in this aircraft as Pilot In Command (sole
manipulator of the controls)?

I affirm that the answers given are true and complete to the best of my
knowledge and belief and that no material information has been withheld.  I
further acknowledge the following:
While my aircraft is being flown during Phase I of its operating limitations
I understand there is no Occupant Liability Coverage.  A test pilot is
considered an occupant of the aircraft and coverage does not apply if he/she
sues the owner for Bodily Injury.
Even if I purchase hull coverage Including Flight, I understand there is no
In-Flight hull coverage when my aircraft is flown during Phase I of the
operating limitations unless: 

1) The aircraft has already first successfully flown 10 hours,
including 10 take offs and 10 full stop landings.

I authorize AVEMCO Insurance Company to investigate all or any
qualifications or statements contained herein.
Date: ____________________________

This information becomes a part of the Insurance Application of:
__________________________ (Quote/Policy Number)