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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