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AVIATION INSURANCE: QUOTE

Please provide as much detail as possible to ensure accuracy!

Name of Insured:

Street Address:

City or Town:

Province:

Postal Code:

Telephone:

Fax:

Email:

Business or Occupation Insured:

Current Insurer:

Expiry Date:

Aircraft Details:

Aircraft Registration:

Year:

Make & Model:

Passenger seats excluding pilot:

Value Wheels $:

Value Skis $:

Value Floats $:

Value Amphibian $:

If aircraft is operated in more than one of these configurations a value must be stated for each configuration!

Aircraft is usually based at:

Hangared:

Tied Down:

Moored:

Use of Aircraft:

Pleasure & Business:

Rental:

Instruction:

Other:

Pilots:	Pilot #1	Pilot #2
Name
Age
Total Flying Time
Total Flying Time ( last 12 months )
Total time on this Aircraft
Total time on Floats
Total time Taildragger
Total multi engine PIC time
Total retractable time
License type and number
Endorsements to licence
Accidents/Incidents ( last 5 years )

Provide extended details regarding the above and any losses or claims.

Coverage Required:

Hull		All risks flight and ground

Liability		$1,000,000 BI/PD Bodily Injury Property Damage Excluding passengers
		$1,000,000 BI/PD Excluding passengers PLUS $100,000 Passenger Legal Liability ( PLL )
		$1,000,000 BI/PD/PLL ( no passenger sub limit )
Excess Liability/Other