Glider Insurance Insurance Proposal Form (Glider Insurance) Contact Details Period of Insurance Glider Ownership - is the aircraft owned or financed? OwnedFinanced If financed (Please provide details) Other Interested Parties Glider Details Glider 1 Glider 2 Glider 3 Make & Model Registration Year of Manufacture 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 glider Is the glider hangared? YESNO YESNO YESNO Trailer Details Trailer 1 Trailer 2 Trailer 3 Make Model Year of Manufacture Purchase Price Does the glinder have any modification, extra or special equipment? YESNO If yes, please provide full details; 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 glider 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 gliders have unrepaired damage? YESNO If yes, please provide full details: Geographical Limits Australia or elsewhere (please advise) Uses Please show, for each glinder, the approximate number of hours for each use over the next 12 months Glider 1 Glider 2 Glider 3 Private, Pleasure, Business (Standard Uses) Competitions Club Uses (excluding Ab-initio Training) Club Uses (including Ab-initio Training) Rental of Air Experience Flights Others: Pilot Information: Glider(hours) Name ARN Type of Licence Total Total Time Make & Model Pilot Information: Motor Glider(hours) Name ARN Type of Licence Total Total Engine Time Total Time Make & Model Please 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 gliders; (if the answer is no, please state no) Had their licence suspended? YESNO If yes, please provide details: Been convicted of a Breach of Air Navigation Safety Regulation? YESNO If yes, please provide details: Been involved in an aircraft incident or accident in the last 5 years? YESNO If yes, please provide details: Claims / Loss History Please give details of all claims, losses or incidents involving damages, liabilities damages, liabilities or other losses associated with any aircraft in which you have been involved in the last 5 years Previous Insurance Have you (personally or as a director or partner of a company) held aircraft hull or liability insurance? YESNO If yes, please provide the following details: Name of Insurer Policy Number Expiry Date Has any insurance ever been canceled or declined, or renewal refused? YESNO If yes, please provide details: Glinder Hull Insurance Cover Required (please amend if necessary) Please confirm the Hull Agreed Value the glider is to be insured for: (Please advise if Insured currency is other than Australian Dollars) Glider 1 Glider 2 Glider 3 Trailer Insurance Cover Required (please amend if necessary) Please confirm the Hull Agreed Value the glider is to be insured for: (Please advise if Insured currency is other than Australian Dollars) Trailer 1 Trailer 2 Trailer 3 Glider Liability Insurance Liability Limit Required (Please advise if Insured currency is other than Australian Dollars) Glider 1 Glider 2 Glider 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
