Proposer/Insured Details

  • Please complete all Sections fully; if you require clarification or assistance in any area, please contact our office for guidance.
  • Period of Insurance

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Hull Coverage

 

Liability Coverage

  • Please state amount of insurance required. It is your responsibility to make sure you choose the correct insurance cover.
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Pilots

  • Pilot 1

  • Split Total Flying Experience into appropriate sub-categories according to the type of Aircraft and proposed operation i.e. muti- engine, turbine, jet, tail-wheel, crop spraying, etc. to be insured here.
  • Give a breakdown of hours over other uses such as aerobatics and crop spraying. Give hours to uses to be insured here.
  • For Rotor Wing specify Total Turbine hours and make and model time where applicable.
  • Any more than three pilots then please contact after form is complete
  • Simulation

  • Please advise if your pilots attend a full motion flight simulation recurrency organisation. If so please confirm the following for each pilot:
  • Accidents

  • Give details of 5-Year accident and claims record of Proposer/Insured and Named Pilots.
  • Convictions

  • Give details of 5-Year convictions of driving a motor vehicle under the influence of alcohol or drugs of Proposer/Insured and Named Pilots
  • Pilot 2

  • Split Total Flying Experience into appropriate sub-categories according to the type of Aircraft and proposed operation i.e. muti- engine, turbine, jet, tail-wheel, crop spraying, etc. to be insured here.
  • Give a breakdown of hours over other uses such as aerobatics and crop spraying. Give hours to uses to be insured here.
  • For Rotor Wing specify Total Turbine hours and make and model time where applicable.
  • Any more than three pilots then please contact after form is complete
  • Simulation

  • Please advise if your pilots attend a full motion flight simulation recurrency organisation. If so please confirm the following for each pilot:
  • Accidents

  • Give details of 5-Year accident and claims record of Proposer/Insured and Named Pilots.
  • Convictions

  • Give details of 5-Year convictions of driving a motor vehicle under the influence of alcohol or drugs of Proposer/Insured and Named Pilots
  • Pilot 3

  • Split Total Flying Experience into appropriate sub-categories according to the type of Aircraft and proposed operation i.e. muti- engine, turbine, jet, tail-wheel, crop spraying, etc. to be insured here.
  • Give a breakdown of hours over other uses such as aerobatics and crop spraying. Give hours to uses to be insured here.
  • For Rotor Wing specify Total Turbine hours and make and model time where applicable.
  • Any more than three pilots then please contact after form is complete
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Purpose of Use

  • (Indicate expected annual utilisation in each Category of Use)
  • Category of Use

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Definitions for Purpose of Use

  • Private Pleasure: Means use for private and pleasure purposes but NOT use for any business or profession not for hire or reward.

    Business: Means the uses stated in Private Pleasure and use for the purpose of the Insured’s business or profession but NOT use for hire or reward

    Commercial: Means the uses stated in private pleasure and Business and use for the carriage by the insured of passengers, baggage accompanying passengers and cargo for hire or reward

    Rental: Means rental, lease, charter or hire by the Insured to any person, company or organization for Private Pleasure and Business uses only, where the operation of the Aircraft is not under the control of the Insured. Rental for any other purpose is NOT insured under this Policy unless specifically declared to Underwriters under SPECIAL RENTAL USES in the schedule.

    Industrial Aid: Shall mean the uses stated for “PRIVATE PLEASURE” and “BUSINESS” also the transport of Executives, Employees, Guests of the Insured, Goods and Merchandise, but excluding any operation for hire or reward or for instruction.

    The above definitions constitute Standard Uses and do not include instruction, Aerobatics, hunting, Patrol, Fire-­‐Fighting, the intentional dropping, spraying or release of anything, any form of experimental or competitive flying, and any other use involving abnormal hazard, but when cover is provided details of such use(s) are stated in the Schedule under SPECIAL USES.

  • Financial Obligations

  • Agreements – Hangarage, ETC

  • Please note that all copies of agreements in respect of Hangarage, and Repair, Sale of Products (fuels, parts etc.), use of airfields, charter or any other Agreements linked to the aircraft must be disclosed to Insurers since these could contain clauses affecting your rights and, by extension, those of Insurers. The waiving of rights or assumption of liability, without Insurers’ knowledge and consent may prejudice your insurance coverage. Copies of any such Agreements should be attached to this proposal and Listed here under.
  • General Liability Information

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Declaration

  • 3. I declare that the statements and declarations given are true and that no information has been withheld that might influence acceptance of this proposed insurance; and I agree that the statements and declarations given above and signed by me shall be the basis of any contract between myself and the Insurer.

    4. This application does not commit the Insurer to any liability and does not make the applicant liable for any premium unless and until the Insurer agrees in writing that coverage has been bound.

  • Insurer’s rely on the proposal form containing all material information about you and that the information is true and complete. Material information is anything that may influence an Insurer’s decision to issue a policy or not or to decide on what terms a policy will be offered to you. If you are unsure if something is material, you must disclose it. If there is any change in the information declared after the date you sign this Proposal form and before any cover offered by Insurers commences, you must advise us immediately. Insurers may alter the terms quoted to you in such circumstances. If you do not make a true and complete disclosure of material information, Insurer’s may elect to cancel your policy or modify the terms on which it was issued. It may prejudice your ability to claim under the policy.

 

Verification

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