Aircraft Proposal Form (Aircraft Proposal) Proposer Details Contact Details Period of Insurance From To Aircraft Ownership Financed or OwnedFinancedOwned Aircraft Details Aircraft 1 Aircraft 2 Aircraft 3 Make & Model Registration Year of Manufacture Land/Float/Amphibious LandFloatAmphibious LandFloatAmphibious LandFloatAmphibious 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? NOYES NOYES NOYES Does the aircraft have any modifications, extra or special equipment?YesNo Will you be undertaking operations that will 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?YesNo 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?YesNo 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 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 Turbine Aircraft(hours) Name ARN Type of Licence Total Time Total Pilot in Command Total Time Make & Model Total Turbine Engine Total Jet Time 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?YesNo Been convicted of a Breach of Air Navigation Safety Regulations?YesNo Been involved in an aircraft incident or accident in the last 5 years?YesNo Claims / Loss History Previous Insurance Have you (personally or as a director or partner of a company) held aircraft hull or liability insurance? YesNo Expiry Date Has any insurance ever been cancelled or declined, or renewal refused?YesNo 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 Cover Required Notes: For Fixed Wing aircraft – Flight, Taxiing and Ground 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 Signing this proposal form does not bind you to complete the Insurance but it is agreed that this form shall be the basis of the contract should a Policy be issued. I / We hereby declare that the foregoing particulars are true and complete to the best of my / our knowledge and belief and I / we agree that this declaration and the answers given herein and any other written statement made by me / us or on my / our behalf for the purpose of the proposed insurance shall be the basis of, and incorporated in, the contract between me / us and the Insurer. Signature of Proposer(s)Date After completion, please save this form and then email to admin@aviationinsurance.com.au The liability of the Insurer does not commence until acceptance of the Proposal and cover is confirmed. Important Note: Sale of your aircraft - post sale liability Please note your Hull & Liability provides no insurance coverage for post sale liabilities for loss or damage caused to third parties in relation to any ownership, maintenance, repair or servicing of your aircraft while you owned or were responsible for the aircraft. Prior to selling your aircraft please refer to our comments on this issue on our website https://aviationinsurance.com.au
