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PDF Proposal Form
Loss of Licence

Aircraft proposal form

* Indicates required field

Name *

First

Last

Address *

Telephone Number *

Email *

Aircraft Type *

Aircraft Registration *

Aircraft Value *

Passenger Seats *

Liability Limit Required *

Minimum Mandatory Limits Crown Indemnity Other Limit Specified below

Required Liability Limit *

Aircraft Uses *

Private Pleasure Only Rental (Hire & Reward) Training (Including Ab-Initio) Training (Advanced only) Parachute Dropping Air Ambulance Aerobatic (include Competitions and Displays) Aerobatics (private only about 1500 AGL) Commerial (inc. Air Taxi) Ground Risks Only Sales and Demonstration Flights

For each pilot please include, name, date of birth, total flying time, time on type (ie, single engine fixed wing etc.), time on make and model, any claims?)

Pilots *

If you prefer and open pilot warranty, please specify the minimum level of experience *

Any pilot with a PPL Any PPL subject to having 100 hours total time Any PPL subject to having 200 hours total time Any PPL subject to having 500 hours total time Any PPL subject to having 1000 hours total time

Where will the aircraft be based and will it be hangared? *

Is the aircraft financed, if so with who and amount? *

Have you or any pilot who will fly this aircraft? (YOU ONLY NEED TO SELECT IF THE STATEMENT APPLIES TO YOU OR A PILOT WHO WILL USE THE AIRCRAFT) *

Any accidents or claims in the last 5 years? Any violations or CAA warnings? Any medical conditions which effect their licence?

If any of the above apply please specify *

Any other information you may consider relevent to your application? *

I confirm that all the information supplied is accurate and up to date. I understand any statement or information which is false may invalidate the insurance. *

I confirm that all information is accurate and up to date.

Submit

Aviation Insurance Professionals

Telephone

+44 (0)7781 103 190

Email

[email protected]