AIRCRAFT INSURANCE QUOTATION REQUEST


OWNER:
ADDRESS:
 
EMAIL ADDRESS:    

BH PHONE: ( ) AH PHONE: ( )

FAX:

( ) MOBILE:


OPERATOR (NAME & LOCATION): (If Applicable)




LOCATION WHERE AIRCRAFT WILL BE KEPT:

WILL IT BE HANGARED?   YES   /      NO


REGISTRATION:

NAME/TYPE:


YEAR MANUFACTURED:

HOW MANY PASSENGER SEATS?
(Excluding Pilot)

 

CATEGORIES OF ESTIMATED HOURS OF USE PREDICTED FOR NEXT 12 MONTHS:

PRIVATE / BUSINESS / PLEASURE:

Hours

ON-LINE HIRE TO OTHERS:

Hours

AB INITIO INSTRUCTION:

Hours

PRIVATE HIRE TO OTHERS:

Hours

ADVANCED INSTRUCTION OR ENDORSEMENT:

Hours

CHARTER:

Hours

MUSTERING, SPRAYING, FIRE FIGHTING, OR "OTHER" (SPECIFY)

Hours



REGULAR PILOTS:

TOTAL HOURS

TOTAL HOURS ON TYPE

HOURS ON TYPE IN LAST 90 DAYS

AGE OF PILOT

1.

2.

3.

4.

 

IF YOU CAN DETERMINE CERTAIN MINIMUM PILOT STANDARDS AND/OR RESTRICT TYPES OF USAGE AND/OR COVER "NAMED" PILOTS ONLY, THIS MAY LOWER THE INSURANCE PREMIUMS. PLEASE ADVISE WHAT MINIMUM STANDARDS WOULD BE ACCEPTABLE IN YOUR CIRCUMSTANCES:

 

DOES A LENDER HAVE A FINANCIAL INTEREST BY WAY OF LEASE, ASSET PURCHASE BILL OF SALE, ETC?   IF SO, ADVISE NAME OF APPLICABLE FINANCE COMPANY OR BANK, AND LOCATION OF BRANCH:


AIRCRAFT PURCHASE PRICE:

$

DATE OF PURCHASE:

  

CURRENT EST. MARKET VALUE:

$

HULL INSURANCE VALUE REQUESTED:

$

 

LIABILITY COVER:

COMBINED SINGLE LIMIT LIABILITY COVER COVERING 3RD PARTY PASSENGER, AND PILOT LIABILITY:
(Tick one.. or more than one if alternatives are sought)
$1.0 MIL.    $2.0 MIL.    $3.0 MIL.    $5.0 MIL.    $10.0 MIL.

 

COMMERCIAL OPERATORS: WOULD YOU LIKE US TO SEEK TO QUOTE ON LOSS OF USE COVER?    Yes    No

IF Yes:
$ PER DAY FOR DAYS, AFTER A WAITING PERIOD OF DAYS



CURRENT INSURANCE CO.:

RENEWAL DATE:

 

ANY AVIATION ACCIDENTS OR CLAIMS? IF SO, PROVIDE DETAILS:

 

ARE QUOTATIONS FOR DEFERRED PAYMENTS REQUESTED?

Yes    No

IF YES, ALTERNATIVES AVAILABLE MAY INCLUDE:

ANNUAL PAYMENT

DEFERRED/PERIODIC INSTALMENT TERMS (provided at no extra cost by the underwriter), PAYMENT CHOICES BEING:
    Half Yearly    40/30/30    Quarterly (large transactions only)

PREMIUM FUNDING. (monthly payments over 9 months, with interest)

 CREDIT CARD (only one of our underwriters offer this facility)
Annual Premium Instalments 1/2 Yearly
Instalments 40/30/30 Instalments Quarterly
     (large transactions only)

 

Please have a representative contact me to discuss other insurances:

Hangarkeepers or Airport Operators Insurance

Pilot Accident Insurance

Professional Pilot Licence Cancellation Insurance

Pilot Income Protection Insurance (interruption or disablement of earning caused by sickness, accident)

Pilot Life Insurance and/or Trauma ("critical conditions") Cover



REMARKS AND ITEMS OF SUPPLEMENTARY INFORMATION OR DISCLOSURE:

 


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