Fixed Wing Proposal FormName of Insured & Owner

     

Address (inc postcode)

     

Mobile      E-mail      

Occupation      

Aircraft Type/Model & Registration

Number of Passenger Seats, MTOW & U/C Type (Fixed or Retractable)

Serial Number & Year of Manufacture

Aircraft Value Inc Fixed Instruments/Avionics

No. of Engines & Type

Parachute Value

Value Of Non Fixed Kit E.g.GPS etc

                                         

PilotsNumber of Pilots Required

1-4 Named

5-10 Named

Unnamed

Club Members Only

Names of Pilots To Be Covered     

Details of Least Experienced Pilot To Fly This

Aircraft

Total Hours:      Hours on Type Insured:      Hours on Similar Types:      License Type:      

When Is Cover Required

Period of Insurance: (dd/mm/yy)       To:      

Full Flight: (dd/mm/yy)       To:      

Ground Risk: (dd/mm/yy)       To:       (must be 60 days minimum)

Estimated Flying Hours Per Year:      

Uses (Your Demands & Needs)

Please describe exactly what the aircraftwill be used for:

Private FlightsTaxi FlightsTowingAir FreightIndustrial Aid (Business Related Flights)PPL SchoolingTraining for higher certificatesParachutingAerobatics below 1500ft AGLAerobatics above 1500ft AGLScenic FlightsPhoto below 1000ft AGLLimited competition flightDealer/Demo FlightsLine inspection below 1000ft AGLAir DisplaysPlease list any other uses not stated above with further details.Please also give details, if any, of Risk Management features that improve your risk profile over others of a similar nature?     

Aircraft Passenger and Third Party LiabilityLegal Limit of Liability Will Be Quoted – If Higher Limit Required Please State £     

Important Additional Information about the AircraftWhere is/are the Aircraft based:Is It Hangared?

          

Will the aircraft be operated outside of Europe (if so please provide full details)

     

Is there any finance on the aircraft: Yes / No. Who?      

Details of any Losses / Claims within the last 5 years of the Insured or any pilot insured to fly the above aircraft:

     

Have the Insured ever been declined insurance:      Current Premium: Who Is Your Broker?No Claims Discount (On Renewal Letter)

£          £      or      %

Do you have any other insurances you would like us to quote on? If so please provide details

     

Further Notes (if required)

     

By submitting this form electronically I hereby declare that to the best of my knowledge and belief the answers to the foregoing questions are true and complete and that I have not withheld any information which might influence the decision of the Insurers with regard to this proposal. I agree that this proposal and declaration shall be the basis of the Contract between me and the Insurers if a policy is issued. Furthermore I authorise Forbes to approach the insurance market on my behalf and I give them exclusive access to Sirius Aviation.