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For specialist insurance to cover your aircraft please complete the following information. We will contact you to discuss an insurance package that best suits your needs.

Your Details    
Registered Owners name:


AOPA Number:  * Discounts may apply
Contact Information    
Telephone Number:
E-mail Address:
How should we contact you? E-mail Telephone
Aircraft Details    
Aircraft Type:
Registration Number:
Passenger Seats:
Craft Uses:
Aircraft is based at:
Stored: Hangar Open
Finance Company: *if any
Encumbered Amount: $
Insurance Specifics  
Sum Insured
Hull: $
Liability CSL: $
Current Insurer:
Expiry Date:
Claims/Accidents in last three years:
Nominated Pilots
Name of Pilot 1:
License Type:
Total hours this craft:
Total hours all craft:
Name of Pilot 2:
License Type:
Total hours this craft:
Total hours all craft:
Your Comments
Other relevant information that may assist us to help you:


Please Note: All information provided by you will be held in the strictest confidence. No third party will be given access to the details provided when completing this form.

Last Modified on: 24/01/14

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