AVIATION QUOTE
 
 
 
 
  Aviation Quote      
         
 

Please take a moment to complete our online application form in order for us to prepare a quotation for your Aviation. All information submitted will be kept private & confidential (see our Privacy Policy).

Please note:
This form is quite lengthy, so you may prefer to download it and complete it at a later stage.

  
 
 
 
GENERAL INFORMATION
Name of Proposer
  
Occupation
  
Age
  
Physical Address of Proposer
  
Postal Address
  
Period of Insurance
   to
Are you now or have you been insured in respect of any aircraft?
   Yes No
If so, state name of company
  
Renewal date
  
Have you ever sustained an Aviation related loss?
   Yes No
If so, state particulars
  
Has any company or underwriter:
Declined your proposal?
   Yes No
Increased your premium or imposed special conditions?
   Yes No
Cancelled or refused to renew your policy?
   Yes No
If so, please provide name of insurer & policy number:
Name
  
Policy No.
  
How long have you owned & operated an aircraft? (e.g. 5yrs 2mths)
 

AIRCRAFT HULL DETAILS
Make of Aircraft
  
Type of Aircraft
  
Serial Number
 
Number of Engines
  
Type of Engines
  
Registration Marks
 
Year of Manufacture
  
Seating Capacity
Note: Excluding pilot
  
Retractable Undercarriage
  Yes No
Nose, Tail, Wheel Version
  
Date of Purchase
  
Price
  
    VAT Excl. Incl.
Insured Value
  
    VAT Excl. Incl.
Estimated flying time during period of insurance
   hours
Use of Aircraft
   Private Business
Pleasure Commercial
Hired for rewards to other pilots for their private business & pleasure
   Yes No

FLYING INSTRUCTION
Abinitio
   Yes No
Advanced
   Yes No
Conversion to type
   Yes No
Dropping of parachutists
   Yes No
Aero clubs
   Yes No
Aerial Survey / Photography
   Yes No
Aerial Ambulance
   Yes No
Flying Doctor Service
   Yes No
Aerial Agriculture
   Yes No
Power Line Patrol
   Yes No
Sales & Demonstration
   Incl Instruction
Excl Instruction
Industrial Aid
"Air Commando" Flying
Any other use, please specify
  

PILOT INFORMATION
Pilot 1
    
Name
  
Age
  
Type of Licence
  
Flying hours (all aircraft)
   Total DUAL
Total SOLO
Flying hours (this type)
   Total DUAL
Total SOLO
Date & details of any flying accidents or offences
 
     
Pilot 2
    
Name
  
Age
  
Type of Licence
  
Flying hours (all aircraft)
   Total DUAL
Total SOLO
Flying hours (this type)
   Total DUAL
Total SOLO
Date & details of any flying accidents or offences
 
     
Pilot 3
    
Name
  
Age
  
Type of Licence
  
Flying hours (all aircraft)
   Total DUAL
Total SOLO
Flying hours (this type)
   Total DUAL
Total SOLO
Date & details of any flying accidents or offences
 
     
Pilot 4
    
Name
  
Age
  
Type of Licence
  
Flying hours (all aircraft)
   Total DUAL
Total SOLO
Flying hours (this type)
   Total DUAL
Total SOLO
Date & details of any flying accidents or offences
 
     
Including CAA approved pilots for contingency purposes
(e.g. certificate of airworthiness, test flight after service overhaul, etc)

LIMITS SECTION
1. Accidental damage to aircraft:
Full flight & ground risks
   or
Ground risks only
  
2. Third party liability any one accident
  
3. Legal liability to passengers:
Per passenger any one accident
 
In all any one accident
  
2 & 3 combined single limit
(3rd party & passenger legal liability)
  
Are you the sole owner of aircraft?
   Yes No
State name of any person, firm or company having a financial interest in or a lien on the aircraft
  
Does Lienholder require breach of warranty cover in respect of such interest?
   Yes No
If so, state amount of lien
  
No. of instalments outstanding
  
Date of last instalment
  
Amount of each instalment
  

MISCELLANEOUS
Address where aircraft will be based
  
Construction of hangar
  
Details of fire precautions
  

GEOGRAPHICAL LIMITS
Standard
   Yes No
The Republic of South Africa & bordering countries excluding Lesotho
other than north & west of a line joining Quthing, Mohaleshoek, Roma & Libono.
If no, please state other
  
Is the aircraft standard production type?
   Yes No
If not please give details of any special features or modifications in design or materials
  
Will the aircraft land or take off from any unlicensed aerodrome?
  Yes No
Will night flying / take offs / landings be undertaken?
   Yes No
What maintenance facilites are available?
  
Will professional aircrew be employed?
   Yes No

The liability of the insurer does not commence until acceptance of this proposal
and the issue of the Policy, unless otherwise agreed.
 
 
 
       
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