Form – Aircraft Proposal Form Proposer DetailsName(Required) First Insured (if different from Name) Address State Postcode Postal Address (if different from Address) State Postcode Contact DetailsEmail(Required) Telephone(Required) Mobile(Required)Period of InsuranceFromFrom DD slash MM slash YYYY ToTo DD slash MM slash YYYY Aircraft OwnershipFinanced or OwnedFinancedOwnedIf financed (Please provide details)Other Interested Parties Aircraft DetailsNumber of Aircrafts123Aircraft 1Make & Model Registration Year of Manufacture Land/Float/AmphibiousLandFloatAmphibiousDate of Purchase 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? No Yes Aircraft 2Make & Model Registration Year of Manufacture Land/Float/AmphibiousLandFloatAmphibiousDate of Purchase 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? No Yes Aircraft 3Make & Model Registration Year of Manufacture Land/Float/AmphibiousLandFloatAmphibiousDate of Purchase 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? No Yes Does the aircraft have any modifications, extra or special equipment? No Yes If yes, please provide full detailsWill 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? No Yes 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? No Yes If yes, please provide full detailsGeographical LimitsCommonwealth of Australia or elsewhere (please advise) Uses Please show, for each aircraft, the approximate number of hours for each use over the next 12 monthsAircraft 1Private, Pleasure Business Commercial / Charter Rental for Private, Pleasure & Business Training including Ab-initio Instruction: Training excluding Ab-initio Instruction: Other Other Aircraft 2Private, Pleasure Business Commercial / Charter Rental for Private, Pleasure & Business Training including Ab-initio Instruction: Training excluding Ab-initio Instruction: Other Other Aircraft 3Private, Pleasure Business Commercial / Charter Rental for Private, Pleasure & Business Training including Ab-initio Instruction: Training excluding Ab-initio Instruction: Other Other Pilot InformationPiston Aircraft(hours)NameDate of BirthARNType of LicenceTotal Flying TimeTotal Time Make & ModelTotal Time Pilot in CommandTotal Time Multi Engine PICTotal Time Retractable Gear PICTotal Time Tail Wheel PICTotal Tail Wheel Landings Add RemoveTurbine Aircraft(hours)NameDate of BirthARNType of LicenceTotal Flying TimeTotal Time Make and ModelTotal Time Pilot in CommandTotal Time Turbine PICTotal Time Jet Time PIC Add RemoveSpecialist Uses(hours)NameTotal Time Fire Fighting PICTotal Time Mustering PICTotal Time General Station UsesTotal Time Aerial AgricultureTotal Time Slung Operations PICTotal Time Aerial Survey WorkTotal Time Other Add RemovePlease advise if any pilot has any special conditions imposed on their licence other than glasses: If Pilots are not individually named, please advise your preferred Pilot Warranty: Pilot details Has any Pilot who will operate any of the proposed aircraft (if the answer is no, please state no)Been convicted of driving whilst intoxicated (drugs and/or alcohol)? No Yes If yes, please provide detailsHad their licence suspended or cancelled? No Yes If yes, please provide detailsHave any physical impairments, waivers, or limitations on their medical certificate? No Yes If yes, please provide detailsBeen convicted of a breach /violation of air navigation safety regulations? No Yes If yes, please provide detailsClaims / Accident / Incident HistoryPlease give details of all claims, losses or incidents involving damages, liabilities or other losses associated with any aircraft in which you have been involved in the last 5 yearsPrevious InsuranceHave you (personally or as a director or partner of a company) held aircraft hull or liability insurance? No Yes Name of Insurer Policy Number Expiry Date DD slash MM slash YYYY Has any insurance ever been cancelled or declined, or renewal refused? No Yes If yes, please provide details:Aircraft Hull Insurance Hull Agreed Value to be insured: Please confirm if currency is other than AUD:Aircraft 1Flight / Taxiing / Ground Ground Risks only Rotors in Motion/Rotors not in Motion Aircraft 2Flight / Taxiing / Ground Ground Risks only Rotors in Motion/Rotors not in Motion Aircraft 3Flight / Taxiing / Ground Ground Risks only Rotors in Motion/Rotors not in Motion Cover RequiredNotes: 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 Third party property damage and bodily injury & passenger legal liability. Please advise if currency is other than AUD:Aircraft 1Combined Single Limit Third Party Liability Aircraft 2Combined Single Limit Third Party Liability Aircraft 3Combined Single Limit Third Party Liability ConsentAs 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 documentationSigning 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)Signature of Proposer(s) Title Date DD slash MM slash YYYY Signature of Proposer(s) Title Date DD slash MM slash YYYY 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
