IMPORTANT
An Insurance Agent who assists an applicant to complete an application or proposal form for insurance shall be deemed to have done so as the agent of the applicant – Section 54 (2) Insurance Act 2003.Please answer ALL questions in full. Use CAPITAL LETTERS.
DETAILS OF PROPOSER
Name of Proposer:
Address:
Name of Aircraft to be Insured:
Passenger Seating Capacity:
Engine Number and Type:
Type of Aircraft and Serial Number:
Year of Construction:
Licensed Seating Capacity:
Registration/Identification Marks:
Value of Extra Equipment:
Number of Aircraft:
Place of Purchase:
Price Paid:
Present Value:
Value of Extra Equipment & Accessories:
Total Value of Aircraft:
Aircraft Flying Destinations:
Geographical Limits of Aircraft:
Location of Maintenance:
Aircraft Parking Locations:
Does the Aircraft Make Use of a Hanger? Yes No
State Construction Type of Hanger:
Frequency of Use:
No. of Hours Flown Till Date:
State Details of All Accidents, Losses During the Last Five Years:
Name of Captain/Assistant:
Age:
Type of Aircraft Flown:
Current License Number:
Current License Expiry Date:
Flying Experience:
Total Nights:
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