* This Report to Aim by: * Email
* Phone AND/OR Fax
* Name Of Insured
Policy Number if available Term
Address of Insured
* Name Of Contact at Insured's
* Contact Phone # to use for Insured AND/OR Fax
Cell Phone if available
Aircraft Registration * Make/Model
Pilot Name
* Date of Loss Time of Loss
* Location of Accident * ANY Injuries YES NO
* Police or Others Contacted:
Please note that only AIM may appoint any adjuster. Upon receipt of this form we will make arrangements for an adjuster to look after this matter. You will be advised of the details
Additional Comments or Details, if any: