Aircraft Proposal Form

(Aircraft Proposal)

Contact Details

Period of Insurance

From
To

Aircraft Ownership
Financed or Owned

Aircraft Details

	Aircraft 1	Aircraft 2	Aircraft 3
Make & Model
Registration
Year of Manufacture
Land/Float/Amphibious
Date of Purchase
Purchase price
Passenger Seats (excluding PIC)
Date of Last maintenance
Hours Flown in last 12 months
Hours Flown in next 12 months(estimate)
Location/Base of aircraft
Is the aircraft hangared?

Does the aircraft have any modifications, extra or special equipment?

Please advise if you will undertake operations that require you to have third party property in your aircraft (that would not constitute being passenger baggage or cargo) e.g. cameras, computer equipment, calibration or other equipment whether fixed to the aircraft or not.

If yes, please provide full details and including items to be insured and replacement value you require these items to be insured for:

Do any aircraft have unrepaired damage?

Geographical Limits

Uses

Please show, for each aircraft, the approximate number of hours for each use over the next 12 months

	Aircraft1	Aircraft2	Aircraft3
Private, Pleasure
Business
Commercial / Charter
Rental for Private, Pleasure & Business
Other
Other
Other

Pilot Information: Piston Aircraft(hours)

Name	ARN	Type of Licence	Total Time	Total Time Make & Model	Total Multi Engine	Total Retractable Gear	Total Tail Wheel

Pilot Information: Turbine Aircraft(hours)

Name	ARN	Type of Licence	Total Time	Total Pilot in Command	Total Time Make & Model	Total Turbine Engine	Total Jet Time

Pilot Information: Specialist Uses(hours)

Name	Fire Fighting	Mustering	General Station Uses	Aerial Agricultural	Slung Operations	Aerial Survey Work	Other*

Pilot details - Has any Pilot who will operate any of the proposed aircraft;

(if the answer is no, please state no)

Had their licence suspended?

Been convicted of a Breach of Air Navigation Safety Regulations?

Been involved in an aircraft incident or accident in the last 5 years?

Claims / Loss History

Previous Insurance

Have you (personally or as a director or partner of a company) held aircraft hull or liability insurance?

Expiry Date

Has any insurance ever been cancelled or declined, or renewal refused?

Aircraft Hull Insurance

	Cover Required (please amend if necessary)	Please confirm the Hull Agreed Value the aircraft is to be insured for: (Please advise if Insured currency is other than Australian Dollars)
Aircraft 1	Flight / Taxiing / Ground
Aircraft 2	Flight / Taxiing / Ground
Aircraft 3	Flight / Taxiing / Ground

Note (Cover Required)
For Rotor Wing aircraft, flight and ground are amended to Rotors in Motion / Rotors
Not in Motion
For Float/Amphibious aircraft, ground can be amended to moored

Aircraft Liability Insurance

	Liability Limit Required (Please advise if Insured currency is other than Australian Dollars)
Aircraft 1
Aircraft 2
Aircraft 3

As part of our ongoing commitment to the environment and to deliver faster and more efficient communication with our clients, we are aiming to send all future correspondence electronically. However, if you would prefer to receive a hard copy of correspondence including underwriters’ policy documentation and invoices, please tick the box below.
I/We would prefer to continue to receive hard copies of all documentation