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Airport & Aircraft
Students: Read and Complete This Entire Form
GENERAL INSTRUCTIONS:
Use the TAB key or MOUSE click to move from field to field.
CAUTION: Using the ENTER key will automatically submit the form.

PLEASE REVIEW YOUR SUBMISSION BEFORE CLICKING "SUBMIT"
Distribution of Certificates
This is a SPECIAL INSURANCE REQUEST, it may take an additional one to two weeks to process your insurance, so start early.
PLAN ACCORDINGLY!!
GENERAL PRODUCTION INFORMATION

Have you submitted the "Production Registration Form"?:
Yes  No

If you answered "No" this will redirect you to the proper Production Registration Form.

Original Name of Production:

Director's Name (No nicknames. List name as registered with NYU!):
First Name:
Last Name:
Insurance Contact - Email Address:
Email address must be an NYU issued email.
Must end in @nyu.edu. All others will be rejected, and your form will have to be resubmitted.

You must provide us with a copy of the Hold Harmless Agreement and Waiver of Subrogation from the Owner or Lessor/Operator of the Airport / Aircraft, in favor of the PRODUCTION COMPANY, CLIENT AND AGENCY.

In addition, we must be provided with a certificate of insurance from the owner or Lessor/Operator of the Airport / Aircraft, evidencing General Liability / Aircraft Liability and Hull physical damage naming the PRODUCTION COMPANY, CLIENT AND AGENCY as additional insureds.

This can be faxed to (212-995-3555) or dropped off at 838 Broadway, 4th Floor.

Location of Airport / Aircraft:


Owner's or Lessor/Operator's Name:


Owner's or Lessor/Operator's Phone Number:


Description of Airport / Aircraft including "N" Registration Number:


Name of Airport / Aircraft Company, contact name, phone and fax numbers:


Details concerning filming, scouting, chartering, etc. activities:


Number of persons in Aircraft at any one time,
and relationship to the Production Company:


The seating capacity of the Aircraft:

Value of hull, if hull insurance is required on the aircraft: $

Name of Pilot and Number of Hours Experience in this Aircraft:


Pilot's License Number:

Pilot's Employer:


If you want a copy of this form for your records, print it before hitting the Submit button!

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