OFM, Risk Management Division - Aviation Policy Form

AVIATION POLICY CHANGE REQUEST

Instruction: For add or delete an aircraft from Aviation Policy. Once the form is submitted, it will send the information you enter to RMD for processing. If you have any questions or problems, please contact RMD customer services at 360.902.7303

Fields in Blue are required on both ADD and DELETE
Fields in Green are required on ADD only
Fields in Brown are optional
If you want to Delete an aircraft, you only need to fill out the Agency Information section, the Aircraft's Year, Make, Model, and Registration number.

Request type:
ADD       DELETE

Agency Information:

Agency:

Effective Date:

Requestor:

Phone:

Email:

Aircraft Information:

Year:

Make: Model:

Registration Number:

Type (FW, RW, etc.):

#of passenger seats:

Value of Aircraft: $

Purpose & Use:

Hull Coverage:

Ground & Flight:
Flight Only:
$
$

Comments/Additional Information:

Request type: ADD DELETE

Agency Information:
Agency:
Effective Date:
Requestor:
Phone:
Email:
Aircraft Information:
Year:
Make:	Model:
Registration Number:
Type (FW, RW, etc.):
#of passenger seats:
Value of Aircraft: $
Purpose & Use:
Hull Coverage:	Ground & Flight: Flight Only:	$ $
Comments/Additional Information: