Contact Details

Period of Insurance

Glider Ownership - is the aircraft owned or financed?

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?


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?

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.

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?

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?

If yes, please provide details:

Been convicted of a Breach of Air Navigation Safety Regulation?

If yes, please provide details:

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

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?

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?

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

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