Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 331 (2011/11)
Pilot Experience
ACORD 331, Pilot Experience, is used to describe pilots and their
experience with different types of aircraft. This form is used in conjunction with ACORD
330, Aircraft Section and ACORD 327, Airport and FBO Liability Section.
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
Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Contact Name
Enter text: The name of the individual at the producer's establishment that is the primary
contact.
IDENTIFICATION SECTION Phone (A/C, No, Ext)
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
IDENTIFICATION SECTION Fax No. (A/C, No, Ext)
Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION E-Mail Address
Enter text: The producer's contact person e-mail address.
IDENTIFICATION SECTION Code
Enter code: The identification code assigned to the producer (e.g. agency or brokerage
firm) by the insurer.
IDENTIFICATION SECTION Subcode
Enter code: The identification code assigned by the insurer to the sub-producer (e.g.
person) within a producer's office (e.g. agency or brokerage).
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION Applicant (First Named Insured)
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION Pilot's Name and address
Enter text: The full name of the pilot.
ACORD 331 (2011/11) rev. 11-23-2011
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION
Enter text: The pilot's mailing address line one.
IDENTIFICATION SECTION
Enter text: The pilot's mailing address city name.
IDENTIFICATION SECTION
Enter code: The pilot's mailing address state or province code.
IDENTIFICATION SECTION
Enter code: The pilot's mailing address postal code.
IDENTIFICATION SECTION Pilot Number
Enter number: The producer assigned number for the pilot.
IDENTIFICATION SECTION Home Phone
Enter number: The pilot's primary phone number. As used here, this is the home phone
number.
IDENTIFICATION SECTION Business Phone
Enter number: The pilot's secondary phone number. As used here, this is the business
phone number.
IDENTIFICATION SECTION Fax No. (A/C, No, Ext)
Enter number: The primary fax number of the pilot.
IDENTIFICATION SECTION E-Mail Address
Enter text: The pilot's primary e-mail address.
PILOT INFORMATION
Date of Birth
Enter date: The birth date of the pilot.
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
PILOT INFORMATION
AOPA Number
Enter identifier: The pilot's Aircraft Owners and Pilots Association (AOPA) number.
PILOT INFORMATION
EAA Number
Enter identifier: The pilot's Experimental Aircraft Association (EAA) number.
PILOT INFORMATION
Airman's Certificate Number
Enter identifier: The pilot's Airman's Certificate Number.
PILOT INFORMATION
Current Employer
Enter text: The name of the pilot's current employer.
PILOT INFORMATION
Hire Date
Enter date: The date the pilot was hired by their current employer.
PILOT INFORMATION
Occupation
Enter text: The pilot's occupation.
PILOT INFORMATION
Registration Numbers of Assigned
Aircraft
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
PILOT INFORMATION
Registration Numbers of Assigned
Aircraft
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
PILOT INFORMATION
Registration Numbers of Assigned
Aircraft
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
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
Registration Numbers of Assigned
Aircraft
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
CERTIFICATIONS AND
RATINGS
Other 1 Description
Enter text: The description of the type of pilot rating.
CERTIFICATIONS AND
RATINGS
Other 2 Description
Enter text: The description of the type of pilot rating.
CERTIFICATIONS AND
RATINGS
Other 3 Description
Enter text: The description of the type of pilot rating.
CERTIFICATIONS AND
RATINGS
Single Engine Land Student
Check the box (if applicable): Indicates the pilot has a student certification for single
engine land aircraft.
CERTIFICATIONS AND
RATINGS
Rotor Wing Student
Check the box (if applicable): Indicates the pilot is certified as a student for rotor wing
aircraft.
CERTIFICATIONS AND
RATINGS
Glider Student
Check the box (if applicable): I Indicates the pilot is certified as a student for glider aircraft.
CERTIFICATIONS AND
RATINGS
Lighter Than Air Student
Check the box (if applicable): Indicates the pilot is certified as a student for lighter than air
aircraft.
CERTIFICATIONS AND
RATINGS
Other Student
Check the box (if applicable): Indicates the pilot is certified as a student for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Student
Check the box (if applicable): Indicates the pilot is certified as a student for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Student
Check the box (if applicable): Indicates the pilot is certified as a student for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Single Engine Land Recreational
Check the box (if applicable): Indicates the pilot has a recreational certification for single
engine land aircraft.
CERTIFICATIONS AND
RATINGS
Glider Recreational
Check the box (if applicable): Indicates the pilot has a recreational certification for glider
aircraft.
CERTIFICATIONS AND
RATINGS
Other Recreational
Check the box (if applicable): Indicates the pilot has a recreational certification for the type
of aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Recreational
Check the box (if applicable): Indicates the pilot has a recreational certification for the type
of aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Recreational
Check the box (if applicable): Indicates the pilot has a recreational certification for the type
of aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Single Engine Land Sport
Check the box (if applicable): Indicates the pilot has a sport certification for single engine
land aircraft.
CERTIFICATIONS AND
RATINGS
Single Engine Sea Sport
Check the box (if applicable): Indicates the pilot has a sport certification for single engine
sea aircraft.
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Section Name
Field Name
Field and/or Section Description
CERTIFICATIONS AND
RATINGS
Rotor Wing Sport
Check the box (if applicable): Indicates the pilot has a sport certification for rotor wing
aircraft.
CERTIFICATIONS AND
RATINGS
Glider Sport
Check the box (if applicable): Indicates the pilot has a sport certification for glider aircraft.
CERTIFICATIONS AND
RATINGS
Other Sport
Check the box (if applicable): Indicates the pilot has a sport certification for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Sport
Check the box (if applicable): Indicates the pilot has a sport certification for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Sport
Check the box (if applicable): Indicates the pilot has a sport certification for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Single Engine Land Private
Check the box (if applicable): Indicates the pilot has a private certification for single engine
land aircraft.
CERTIFICATIONS AND
RATINGS
Multi-Engine Land Private
Check the box (if applicable): Indicates the pilot has a private certification for multi-engine
land aircraft.
CERTIFICATIONS AND
RATINGS
Instrument Private
Check the box (if applicable): Indicates the pilot has a private certification for instrument
flying..
CERTIFICATIONS AND
RATINGS
Single Engine Sea Private
Check the box (if applicable): Indicates the pilot has a private certification for single engine
sea aircraft.
CERTIFICATIONS AND
RATINGS
Multi-Engine Sea Private
Check the box (if applicable): Indicates the pilot has a private certification for multi-engine
sea aircraft.
CERTIFICATIONS AND
RATINGS
Rotor Wing Private
Check the box (if applicable): Indicates the pilot has a private certification for rotor wing
aircraft.
CERTIFICATIONS AND
RATINGS
Glider Private
Check the box (if applicable): Indicates the pilot has a private certification for glider
aircraft.
CERTIFICATIONS AND
RATINGS
Lighter Than Air Private
Check the box (if applicable): Indicates the pilot has a private certification for lighter than
air aircraft.
CERTIFICATIONS AND
RATINGS
Other Private
Check the box (if applicable): Indicates the pilot has a private certification for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Private
Check the box (if applicable): Indicates the pilot has a private certification for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Private
Check the box (if applicable): Indicates the pilot has a private certification for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Single Engine Land Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for single
engine land aircraft.
CERTIFICATIONS AND
RATINGS
Multi-Engine Land Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for multi-
engine land aircraft.
ACORD 331 (2011/11) rev. 11-23-2011
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Section Name
Field Name
Field and/or Section Description
CERTIFICATIONS AND
RATINGS
Instrument Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for
instrument flying..
CERTIFICATIONS AND
RATINGS
Single Engine Sea Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for single
engine sea aircraft.
CERTIFICATIONS AND
RATINGS
Multi-Engine Sea Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for multi-
engine sea aircraft.
CERTIFICATIONS AND
RATINGS
Rotor Wing Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for rotor
wing aircraft.
CERTIFICATIONS AND
RATINGS
Glider Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for glider
aircraft.
CERTIFICATIONS AND
RATINGS
Lighter Than Air Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for lighter
than air aircraft.
CERTIFICATIONS AND
RATINGS
Other Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for the type
of aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for the type
of aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Commercial
Check the box (if applicable): Indicates the pilot has a commercial certification for the type
of aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Single Engine ATP
Check the box (if applicable): Indicates the pilot has a certification as an airline transport
pilot for single engine aircraft.
CERTIFICATIONS AND
RATINGS
Multi-Engine ATP
Check the box (if applicable): Indicates the pilot has a certification as an airline transport
pilot for multi-engine aircraft.
CERTIFICATIONS AND
RATINGS
Instrument ATP
Check the box (if applicable): Indicates the pilot has a certification as an airline transport
pilot for instrument flying..
CERTIFICATIONS AND
RATINGS
Single Engine Sea ATP
Check the box (if applicable): Indicates the pilot has a certification as an airline transport
pilot for single engine sea aircraft.
CERTIFICATIONS AND
RATINGS
Multi-Engine Sea ATP
Check the box (if applicable): Indicates the pilot has a certification as an airline transport
pilot for multi-engine sea aircraft.
CERTIFICATIONS AND
RATINGS
Rotor Wing ATP
Check the box (if applicable): Indicates the pilot has a certification as an airline transport
pilot for rotor wing aircraft.
CERTIFICATIONS AND
RATINGS
Lighter Than Air ATP
Check the box (if applicable): Indicates the pilot has a certification as an airline transport
pilot for lighter than air aircraft.
CERTIFICATIONS AND
RATINGS
Other ATP
Check the box (if applicable): Indicates the pilot has a certification as an airline transport
pilot for the type of aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other ATP
Check the box (if applicable): Indicates the pilot has a certification as an airline transport
pilot for the type of aircraft or rating listed.
ACORD 331 (2011/11) rev. 11-23-2011
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Section Name
Field Name
Field and/or Section Description
CERTIFICATIONS AND
RATINGS
Other ATP
Check the box (if applicable): Indicates the pilot has a certification as an airline transport
pilot for the type of aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Single Engine Land Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for single
engine land aircraft.
CERTIFICATIONS AND
RATINGS
Multi-Engine Land Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for multi-
engine land aircraft.
CERTIFICATIONS AND
RATINGS
Instrument Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for instrument
flying..
CERTIFICATIONS AND
RATINGS
Single Engine Sea Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for single
engine sea aircraft.
CERTIFICATIONS AND
RATINGS
Multi-Engine Sea Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for multi-
engine sea aircraft.
CERTIFICATIONS AND
RATINGS
Rotor Wing Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for rotor wing
aircraft.
CERTIFICATIONS AND
RATINGS
Glider Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for glider
aircraft.
CERTIFICATIONS AND
RATINGS
Lighter Than Air Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for lighter than
air aircraft.
CERTIFICATIONS AND
RATINGS
Other Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Instructor
Check the box (if applicable): Indicates the pilot is certified as an instructor for the type of
aircraft or rating listed.
CERTIFICATIONS AND
RATINGS
Other Type
Enter text: The type of certification.
CERTIFICATIONS AND
RATINGS
Single Engine Land Other
Check the box (if applicable): Indicates the pilot is certified for single engine land aircraft.
CERTIFICATIONS AND
RATINGS
Multi-Engine Land Other
Check the box (if applicable): Indicates the pilot is certified for multi-engine land aircraft.
CERTIFICATIONS AND
RATINGS
Instrument Other
Check the box (if applicable): Indicates the pilot is certified for instrument flying.
CERTIFICATIONS AND
RATINGS
Single Engine Sea Other
Check the box (if applicable): Indicates the pilot is certified for single engine sea aircraft.
CERTIFICATIONS AND
RATINGS
Multi-Engine Sea Other
Check the box (if applicable): Indicates the pilot is certified for multi-engine sea aircraft.
ACORD 331 (2011/11) rev. 11-23-2011
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Section Name
Field Name
Field and/or Section Description
CERTIFICATIONS AND
RATINGS
Rotor Wing Other
Check the box (if applicable): Indicates the pilot is certified for rotor wing aircraft.
CERTIFICATIONS AND
RATINGS
Glider Other
Check the box (if applicable): Indicates the pilot is certified for glider aircraft.
CERTIFICATIONS AND
RATINGS
Lighter Than Air Other
Check the box (if applicable): Indicates the pilot is certified for lighter than air aircraft.
CERTIFICATIONS AND
RATINGS
Other
Check the box (if applicable): Indicates the pilot is certified for the type of aircraft or rating
listed.
CERTIFICATIONS AND
RATINGS
Other
Check the box (if applicable): Indicates the pilot is certified for the type of aircraft or rating
listed.
CERTIFICATIONS AND
RATINGS
Other
Check the box (if applicable): Indicates the pilot is certified for the type of aircraft or rating
listed.
CERTIFICATIONS AND
RATINGS
Are you and A&P Mechanic? Yes
Check the box (if applicable): Indicates a Yes response to the question, Are you an A&P
mechanic.
CERTIFICATIONS AND
RATINGS
Are you and A&P Mechanic? No
Check the box (if applicable): Indicates a No 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
Are you an Inspection Authority?
Yes
Check the box (if applicable): Indicates a Yes response to the question, Are you an
inspection authority (I/A).
CERTIFICATIONS AND
RATINGS
Are you an Inspection Authority?
No
Check the box (if applicable): Indicates a No response to the question, Are you an
inspection authority (I/A).
CERTIFICATIONS AND
RATINGS
Date obtained
Enter date: The date the inspection authority (I/A) certification was obtained.
CERTIFICATIONS AND
RATINGS
Medical Date
Enter date: The date the medical certification was obtained.
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.
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.
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Section Name
Field Name
Field and/or Section Description
LOGGED HOURS
Total Hours
Enter number: The total number of hours the pilot has logged.
LOGGED HOURS
Pilot in Command
Enter number: The number of hours the pilot has logged as a pilot in command.
LOGGED HOURS
Second in Command
Enter number: The number of hours the pilot has logged as second in command.
LOGGED HOURS
Multi-Engine Land
Enter number: The number of hours the pilot has logged in multi-engine land aircraft.
LOGGED HOURS
Retractable Gear
Enter number: The number of hours the pilot has logged in aircraft with retractable gear.
LOGGED HOURS
Conventional Gear
Enter number: The number of hours the pilot has logged in aircraft with conventional gear.
LOGGED HOURS
Total Seaplane
Enter number: The total number of hours the pilot has logged in seaplanes.
LOGGED HOURS
Multi-Engine Seaplane
Enter number: The number of hours the pilot has logged in multi-engine seaplanes.
LOGGED HOURS
Total amphibious
Enter number: The total number of hours the pilot has logged in amphibious aircraft.
LOGGED HOURS
Rotor Wing
Enter number: The number of hours the pilot has logged in rotor wing aircraft.
LOGGED HOURS
Turbine Rotor Wing
Enter number: The number of hours the pilot has logged in turbine rotor wing aircraft.
LOGGED HOURS
Total Agriculture
Enter number: The total number of hours the pilot has logged in agriculture aircraft.
LOGGED HOURS
Turbine Agriculture
Enter number: The number of hours the pilot has logged in turbine agriculture aircraft.
LOGGED HOURS
Rotor Wing AG
Enter number: The number of hours the pilot has logged in rotor wing agriculture aircraft.
LOGGED HOURS
Turbine Rotor Wing AG
Enter number: The number of hours the pilot has logged in turbine rotor wing agriculture
aircraft.
LOGGED HOURS
Alaska
Enter number: The number of hours the pilot has logged in Alaska.
LOGGED HOURS
Instrument
Enter number: The number of hours the pilot has logged with instruments.
LOGGED HOURS
Total Turbine
Enter number: The total number of hours the pilot has logged in turbine aircraft.
LOGGED HOURS
Turbo Jet
Enter number: The number of hours the pilot has logged in turbo jets.
LOGGED HOURS
Turbo Prop
Enter number: The number of hours the pilot has logged in turbo prop aircraft.
LOGGED HOURS
SE Turbo Prop
Enter number: The number of hours the pilot has logged in single engine turbo prop
aircraft.
LOGGED HOURS
Last 90 Days
Enter number: The number of hours the pilot has logged in the last 90 days.
LOGGED HOURS
Last 12 Months
Enter number: The number of hours the pilot has logged in the last 12 months.
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
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
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
Other
Enter text: The description of the type of hours logged by the pilot.
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Section Name
Field Name
Field and/or Section Description
LOGGED HOURS
Other Hours
Enter number: The number of hours logged by the pilot.
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
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
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
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? Yes
Check the box (if applicable): Indicates the pilot receives annual recurrent training in this
type of aircraft.
AIRCRAFT APPROVAL
Annual Recurrent Training? No
Check the box (if applicable): Indicates the pilot does not receive annual recurrent training
in this type of aircraft.
AIRCRAFT APPROVAL
Current FSI Card? Yes
Check the box (if applicable): Indicates the pilot holds a current Flight Safety International
(FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL
Current FSI Card? No
Check the box (if applicable): Indicates the pilot does not hold 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
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? Yes
Check the box (if applicable): Indicates the pilot receives annual recurrent training in this
type of aircraft.
AIRCRAFT APPROVAL
Annual Recurrent Training? No
Check the box (if applicable): Indicates the pilot does not receive annual recurrent training
in this type of aircraft.
AIRCRAFT APPROVAL
Current FSI Card? Yes
Check the box (if applicable): Indicates the pilot holds a current Flight Safety International
(FSI) Pro card or Simuflite card for this aircraft.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT APPROVAL
Current FSI Card? No
Check the box (if applicable): Indicates the pilot does not hold 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
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? Yes
Check the box (if applicable): Indicates the pilot receives annual recurrent training in this
type of aircraft.
AIRCRAFT APPROVAL
Annual Recurrent Training? No
Check the box (if applicable): Indicates the pilot does not receive annual recurrent training
in this type of aircraft.
AIRCRAFT APPROVAL
Current FSI Card? Yes
Check the box (if applicable): Indicates the pilot holds a current Flight Safety International
(FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL
Current FSI Card? No
Check the box (if applicable): Indicates the pilot does not hold 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
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? Yes
Check the box (if applicable): Indicates the pilot receives annual recurrent training in this
type of aircraft.
AIRCRAFT APPROVAL
Annual Recurrent Training? No
Check the box (if applicable): Indicates the pilot does not receive annual recurrent training
in this type of aircraft.
AIRCRAFT APPROVAL
Current FSI Card? Yes
Check the box (if applicable): Indicates the pilot holds a current Flight Safety International
(FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL
Current FSI Card? No
Check the box (if applicable): Indicates the pilot does not hold a current Flight Safety
International (FSI) Pro card or Simuflite card for this aircraft.
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Section Name
Field Name
Field and/or Section Description
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
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? Yes
Check the box (if applicable): Indicates the pilot receives annual recurrent training in this
type of aircraft.
AIRCRAFT APPROVAL
Annual Recurrent Training? No
Check the box (if applicable): Indicates the pilot does not receive annual recurrent training
in this type of aircraft.
AIRCRAFT APPROVAL
Current FSI Card? Yes
Check the box (if applicable): Indicates the pilot holds a current Flight Safety International
(FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL
Current FSI Card? No
Check the box (if applicable): Indicates the pilot does not hold 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
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? Yes
Check the box (if applicable): Indicates the pilot receives annual recurrent training in this
type of aircraft.
AIRCRAFT APPROVAL
Annual Recurrent Training? No
Check the box (if applicable): Indicates the pilot does not receive annual recurrent training
in this type of aircraft.
AIRCRAFT APPROVAL
Current FSI Card? Yes
Check the box (if applicable): Indicates the pilot holds a current Flight Safety International
(FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL
Current FSI Card? No
Check the box (if applicable): Indicates the pilot does not hold a current Flight Safety
International (FSI) Pro card or Simuflite card for this aircraft.
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Section Name
Field Name
Field and/or Section Description
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
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? Yes
Check the box (if applicable): Indicates the pilot receives annual recurrent training in this
type of aircraft.
AIRCRAFT APPROVAL
Annual Recurrent Training? No
Check the box (if applicable): Indicates the pilot does not receive annual recurrent training
in this type of aircraft.
AIRCRAFT APPROVAL
Current FSI Card? Yes
Check the box (if applicable): Indicates the pilot holds a current Flight Safety International
(FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL
Current FSI Card? No
Check the box (if applicable): Indicates the pilot does not hold 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
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? Yes
Check the box (if applicable): Indicates the pilot receives annual recurrent training in this
type of aircraft.
AIRCRAFT APPROVAL
Annual Recurrent Training? No
Check the box (if applicable): Indicates the pilot does not receive annual recurrent training
in this type of aircraft.
AIRCRAFT APPROVAL
Current FSI Card? Yes
Check the box (if applicable): Indicates the pilot holds a current Flight Safety International
(FSI) Pro card or Simuflite card for this aircraft.
AIRCRAFT APPROVAL
Current FSI Card? No
Check the box (if applicable): Indicates the pilot does not hold a current Flight Safety
International (FSI) Pro card or Simuflite card for this aircraft.
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Section Name
Field Name
Field and/or Section Description
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.
GENERAL INFORMATION
1. Do you participate in the FAA
pilot proficiency award program?
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.
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?.
ACORD 331 (2011/11) rev. 11-23-2011
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Section Name
Field Name
Field and/or Section Description
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether you have any physical impairments, limitations, or
waivers on a medical certificate.
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 as to whether you ever had an aircraft accident or incident or
been penalized for an FAR violation.
GENERAL INFORMATION
5. Has any insurance company or
underwriter cancelled, or refused
to renew any insurance on your
behalf? (Missouri Applicants - Do
not answer thisa question)
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 as to whether any insurance company or underwriter cancelled,
or refused to renew any insurance on your behalf? (Missouri Applicants - Do not answer
this question).
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 as to whether you ever been convicted of driving a motor
vehicle under the influence of alcohol or narcotics, or of reckless driving.
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 as to whether any drivers license has been suspended /
revoked?
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 as to whether you have ever been convicted of or under
indictment in a legal action involving drugs or narcotics.
REMARKS
Remarks
Enter text: The remarks associated with the pilot's experience. Use this section to provide
any additional information required for underwriting or rating. ACORD 101, Additional
Remarks Schedule, may be attached if more space is required.
ACORD 331 (2011/11) rev. 11-23-2011
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Section Name
Field Name
Field and/or Section Description
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.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
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