Fixed Wing Aviation Application

Should the insured conceal, misrepresent or fail to disclose any fact or circumstance which affects coverage or its formation, coverage will be voidable from inception.

Name of Applicant
First Last
Name aircraft to be insured in
First Last
Address of Applicant
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Email
Aircraft
Aircraft Make*
Aircraft Model*
Year of Manufacture
Registration / serial number
Value
Passenger Seats
Limits Required for Third Party and Passenger Liability
Pilots*
Name Occupation Date of Birth
For each pilot listed above...*
(list in same order as above)
Licence Ratings
For each pilot listed above...*
(list in same order as above)
Total Hours Flown Hours on Type Hours on Make and Model
Full description of aircraft uses
Annual utilisation of aircraft
(how many hours aircraft being flown per annum)
Amount of hours per use
Is aircraft financed?
Advise amount and to whom
Where is aircraft based?*
Hangared?*
Geographical Limits required
How many years have you owned this aircraft?
When is insurance due*
MM slash DD slash YYYY
Claims record last five years advising date of loss, amount paid and brief circumstances of loss (all pilots and all Insureds)
Signature*
Date
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

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AVN1C DEFINITIONS

“ACCIDENT” means any one accident or series of accidents arising out of one event.
“UNIT” means a part or an assembly of parts (including any sub-assemblies) of the Aircraft which has been assigned an Overhaul Life as a part or an assembly. Nevertheless, an engine complete with all parts normally attached when removed for the purpose of overhaul or replacement shall together constitute a single Unit.
“OVERHAUL LIFE” means the amount of use, or operational and/or calendar time which, according to the Airworthiness Authority, determines when overhaul or replacement of a Unit is required.
“OVERHAUL COST” means the costs of labour and materials which are or would be incurred in overhaul or replacement (whichever is necessary) at the end of the Overhaul Life of the damaged or a similar Unit.
“PRIVATE PLEASURE” means use for private and pleasure purposes but NOT use for any business or profession nor for hire or reward.
“BUSINESS” means the uses stated in Private Pleasure and use for business or professional purposes but NOT use for hire or reward.
“COMMERCIAL” means the uses stated in Private Pleasure and Business and use for the carriage by the Insured of passengers, baggage accompanying passengers and cargo for hire or reward.
“RENTAL” means rental, lease, charter or hire by the Insured to any person, company or organisation for Private Pleasure and Business uses only, where the operation of the Aircraft is not under the control of the Insured. Rental for any other purpose is NOT insured under this Policy unless specifically declared to Insurers and the detail of such use(s) stated in Part 3 of the Schedule under SPECIAL RENTAL USES.Definitions 5, 6, 7 and 8 constitute Standard Uses and do not include instruction, aerobatics, hunting, patrol, fire-fighting, the intentional dropping, spraying or release of anything, any form of experimental or competitive flying, and any other use involving abnormal hazard, but when cover is provided details of such use(s) are stated in Part 3 of the Schedule under SPECIAL USES.
“FLIGHT” means from the time the Aircraft moves forward in taking off or attempting to take off, whilst in the air, and until the Aircraft completes its landing run. A rotary-wing aircraft shall be deemed to be in Flight when the rotors are in motion as a result of engine power, the momentum generated therefrom, or autorotation.
“TAXIING” means movement of the Aircraft under its own power other than in Flight as defined above. Taxiing shall not be deemed to cease merely by reason of a temporary halting of the Aircraft.
“MOORED” means, in the case of aircraft designed to land on water, whilst the Aircraft is afloat and is not in Flight or Taxiing as defined above, and includes the risks of launching and hauling up.
“GROUND” means whilst the Aircraft is not in Flight or Taxiing or Moored as defined above.

Fixed Wing Aviation Application

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AVN1C DEFINITIONS

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Name	Occupation	Date of Birth

Licence	Ratings

Total Hours Flown	Hours on Type	Hours on Make and Model