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Home Forms Roto-Wing Aviation Application

Roto-Wing Aviation Application

Step 1 of 2

Personal Details
Name of Proposer
First Last
Name of Insured (if different)
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Email*
Date from which cover is required*
MM slash DD slash YYYY
Details of Aircraft to be Insured
Airframe/Engine*
Make Year of Construction Licensed Passenger Seating Capacity Registration
Value
Present Value* of Aircraft Accessories (Type) Accessories (Value) Total Declared Value
* You should carefully consider the fact that Robinson R22 and R44 Aircraft are time expired at 2200 hours or 12 years in respect of airframe and engine as this will have an effect on the value of the aircraft.
Coverage Required
Loss of Damage to Aircraft
- Rotors in Motion and Rotors Not in Motion
- Rotors Not in Motion
A Combined Single Limit for Third Party and Passenger Legal Liability
Limit of Indemnity on any one accident
or alternatively
Legal Liability to Third Parties (other than Passengers)
Limit of Indemnity on any one accident
Legal Liability to Passengers
Limit of Indemnity any one Passenger on any one accident
Pilots*
Name Date of Birth Valid Licences Held
For each pilot listed...*
(List in same order as above)
Make and Model of Aircraft Flown Date of Last Flight
For each pilot listed... Logged Rotor Wing Flying Hours P1*
(List in same order as above)
For Make and Model Proposed Logged Hours for all Helicopters

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