Aproposal Form

AIRCRAFT INSURANCE PROPOSAL

Please complete the appropriate sections:

We require some personal details

Surname

First Names

Address 1

Address 2

Town Post Code

County Email Address

Telephone Number

Age yrs. Married Single

Occupation

Pilot's Name (if different from above)

Type of Aircraft

Registration Number Number of Passenger Seats

Price Paid Ł Where is Aircraft Normally Kept

Is Aircraft Kept in a Hanger

Total Number of Flying Hours Total Number on this Type Hrs.

Please Specify Type of Licence Held

Please Specify Rating

Please State the Amount of Third Party and Passenger Liability Cover Required Ł

Do you wish to include M.O.D. Airfield Liability

Do you wish to include Liability Cover for Germany Denmark

Private Pleasure Use (including your own business use) Commercial Use

Basic cover provides an operating area of UK and Europe, if you require cover outside these limits please provide details:-

Please Give Details of any Accidents or Claims made in the Last 5 Years:-

If you have any other information that you may consider relevant to this application please specify in the space provided:-

Please check that all the information that you have given, is to the best of your knowledge true and accurate. Then please submit the form for consideration

Please NOTE that by submitting this Form we consider it to be electronically signed.

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