Proposer Details

NAME

OCCUPATION

STREET/AREA

POSTAL TOWN

POST CODE

Proposer Contact Details

LANDLINE

MOBILE

Owner Details (if different to proposer)

Owner Name

Contact

Street/Area

Postal Town

Post Code

Aircraft Details

Aircraft Manufacturer & Type

Pure Glider, Turbo or Self Launch

Engine Type (if fitted)

MTOM (Kg)

Number of Passenger Seats

U/C Type Fixed/Retractable

Registration

Serial Number

Year of Manufacture

Estimate Utilisation Per Year

Aircraft & Trailer Values

Aircraft Value (including all fixed instruments, radio, headsets and other permanently fitted items)

Trailer Value

Ancillary Item Values

Parachute Value

Non Fixed Items Value (GPS, PDAs, Loggers etc)

Details Of Pilots To Fly This Aircraft

Pilot 1

Pilot Name

Pilot Date of Birth

Glider Hours

BGA Badges

Licence Type

Hours On Type

Pilot 2

Pilot Name

Pilot Date of Birth

Glider Hours

BGA Badges

Licence Type

Hours On Type

Pilot 3

Pilot Name

Pilot Date of Birth

Glider Hours

BGA Badges

Licence Type

Hours On Type

Pilot 4

Pilot Name

Pilot Date of Birth

Glider Hours

BGA Badges

Licence Type

Hours On Type

Cover Required

Cover Start & End Dates (all dates in format dd/mm/yy)

Full Flight Risk Start and End Dates

Ground Risk Start & End Dates

Private

No yes

Club

No yes

Instruction (schooling)

No yes

Display/Competition Aerobatics (if yes specify in further notes)

No yes

Towing Gliders (SLMG e.g. Rotax Falke Grob109)

No yes

Rated/Non Rated Competitions (automatically covered)

No yes

Others (describe in comments field)

No yes

Aircraft Passenger & Third Party Liability

Legal Limit of Liability Will Be Quoted i if higher limit please state below

Important Additional Information About The Aircraft

Aircraft Base/Hangared

Any outstanding finance on Aircraft

No yes

Current Premium/CurrentBroker

No Claims Discount Amount

No Claims Discount Percentage

Losses/Claims in last 5 years, if yes please provide details in further notes

No yes

Do you have any other insurances you would like a quote on? If so provide details

Has insured ever been declined insurance

No yes

Further Notes

Has insured ever been declined insurance

By submitting this proposal I hereby declare that to the best of my knowledge and belief that the answers to the foregoing questions are true and complete and that I have not withheld any information which might influence the decision of the insurers with regard to this proposal. I agree that this proposal and declaration shall be the basis of the Contract between myself and the insurers if a policy is issued.

Insurance

Buisness Insurance
Aviation Insurance
Personal Insurance

Contact us

Forbes Insurance Limited is registered in England No: 7885596
Forbes Insurance Registered Address: Press House, Narborough Wood Business Park, Desford Road, Enderby, Leicester, LE19 4XT. Forbes Insurance Limited is an appointed representative of Momentum Broker Solutions Limited which is authorised and regulated by the Financial Conduct Authority.