Personal Firearms

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You will receive a proposal and payment option within 48 hours. Appropriate state filings for your license will be made upon receipt of payment.

* Due to the very low rates of this program some society members may not qualify for coverage.

CSL= combined coverage single limit of liability. Coverage included civil defense, criminal defense, and judgements/ awards.

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Member Information

Member Information

Mailing Address (If Different)

Have you ever been convicted of a felony? *

Are you currently an active member of FBI National Academy Association?

Coverage Information

CRIMINAL DEFENSE COST PROVIDED UP TO 100% OF LIMIT PURCHASED

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Disclosure/Authorization/Declarations

WARNING NOTICE: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement, is guilty of insurance fraud.

The undersigned Applicant authorizes the Company, its agents, and representatives to secure claims information from my current and previous insurance carriers.

Acknowledgement, consent and waiver: Upon purchase coverage will be placed with Conifer Insurance company which is rated by A.M. Best Company as B++. The agent, employees, independent contractors, directors and officers make no representation as to the financial status of the insurance carrier. The undersigned requests and grants authority to place coverage as described above.

The undersigned declares that to the best of their knowledge and belief the statements set forth herein are true. The signing of this application does not bind the undersigned to purchase insurance, nor does review of the application bind the insurer to issue a policy. It is agreed, however, that this application shall be the basis of the contract should a policy be issued.

Typed name constitutes signature for application/disclosure purposes