On-line Aircraft Insurance


Thank you for considering our on-line aircraft insurance service.   Because Greater National Group is an insurance broker, not an insurance company, we will process your application with major insurance companies in order to find you the right aircraft insurance for you.

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond with your terms as soon as we have researched the market for the right available deals that fit your requirements.


1. Period of insurance from:
am pm  to: am pm
2a. Are you the owner of the aircraft?
Yes No
If not, describe the nature of your interest
2b. Please state the name of any other person, firm or company who have a financial interest in the aircraft and describe the nature of their interest
3. Aircraft Details:
Aircraft 1 Aircraft 2 Aircraft 3
Make and Model Year
Year manufactured
Registration Marks
Passenger Seats
Purchase Price
Market Value
Amount to be insured
Hours Flown
4. Please provide details of any modifications, extras or special equipment
5a. Condition of aircraft
5b. Is there any unrepaired damage?
Yes No
If yes, please provide details
6. Range of operation
7. Name of organisation maintaining aircraft:
8. Purpose of Use (Please show, for each aircraft, the approximate number of hours for each use over the next 12 months):
Use Aircraft 1 Aircraft 2 Aircraft 3
Private Pleasure (excludes business and professional use and for hire and reward)
Business (includes use for pricate pleasure, business or professional use but not use for hire and reward)
Commercial/Charter (includes private pleasure, business uses and the carriage of passengers, baggage accompanying passengers and cargo for hire or reward)
Flying School excluding instruction
Aero Club excluding instruction
Instruction including ab-initio
General Station use (includes baiting, shooting but excludes mustering
Mustering
Agricultural Work (includes spraying, seeding, dusting, fertilising)
Aerobatics
Parachute Operations
Hire and/or Rental Private Pleasure and Business uses only (for other hire and/or rental uses see question 9)
Other uses (please describe)
Special Hire and/or Rental Uses
(To be completed if the aircraft is hired or rented to other persons, firms or organizations for other than Private Pleasure or Business uses)
9a. Name of the hirer or renter:
9b. Describe special use permitted under the hire/rental agreement:
9c. Flying experience of pilots allowed under the agreement:
9d. Estimated number of hours involved in the next 12 months:
Previous Insurance
10a. Have you (or a corporation of which you were a director or, if the proposer is a corporation, a person who is a director of the proposer) previously held an aircraft insurance policy?
Yes No
If yes, please provide the following details
Name of Insurer Policy Number Expiry Date
10b. Has any insurer cancelled, declined or refused to renew any such insurance policy?
Yes No
If yes, please provide details
Pilot Information
(required for all pilots who operate the aircarft)
11a. Pilot details and Experience
Pilot 1 Pilot 2 Pilot 3
Pilot's name
Age
Type of license
Ratings
Flying experience in command (in hours)
Total time
Single engined aircraft
Multi engined aircraft
Last 12 months
Last 90 days
Make and model proposed - total time
Make and model proposed - last 90 days
11b. If pilots are not named, indicate preferred pilot warranty
11c. Provide detail of training courses attended in the last 2 years
11d. Has any pilot named above ever had their license suspended or cancelled?
Yes No
If yes, please provide details
11e. Has any pilot named above been convicted of a breach of Air Navigation safety regulations?
Yes No
If yes, please provide details
11f. Has any pilot named above been involved in an aircraft accident in the past 5 years?
Yes No
If yes, please provide details
11g. Has any pilot named above been convicted of driving a motor vehicle under the influence of drugs or alcohol during the last 5 years?
Yes No
If yes, please provide details
Loss Experience
12. Give details of all accidents involving aircraft or liabilities associated with aircraft in which you have been involved in the last 5 years
Convictions
13. Have you ever been convicted of a breach of Air Navigation safety regulations?
Yes No
If yes, please provide details
Details of Insurnace Required
14. Accidental Dammage to Aircraft Hull
Cover (Flight and/or Ground Risk) Amount Proposed For insurance Excess
1 $ $
2 $ $
3 $ $
Liability
15a.
    Value
Legal liability to third parties for property damage and bodiliy injury AND also to passengers Combines Single Limit of Indemnity $
15b. Is this cover to include legal liability to the pilot in command?
Yes No
15c.
    Value
Legal liability to third parties for property damage and bodily injury (excluding passengers) Limit of indemnity $
Legal liability to passengers Limit of indemnity and one passenger $
OR
Legal liability to third parties for property damage and bodily injury (excluding passengers) Limit of indemnity all passengers (single limit) $
Legal liability to Pilot in Command Limit of indemnity $
Additional Cover Options
16a. Passenger Liability - Cover in Terms of Civil Aviation (Carriers Liability) act (Commonwealth or Ste as applicable) - is this required?
Yes No
16b.
    Value
Aircraft of Parts If required show amount of cover $
A Loss of Use If required show - number of days cover   
Note: Cover is excluded for the first days following an accident Amount of cover per day $


Duty of Disclosure:
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?
Yes No
If so, please provide details:
I/We hereby declare that:

My/Our attention has been drawn to the Important Notices accompanying this form and further I/we have read these notices carefully and acknowledge my/our understanding of their content. The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this form and the inception date of the insurance to which this relates I/we shall give immediate notice thereof. I/We authorise GNG and the Insurer to collect or disclose any personal information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact and the Privacy Policy. I/We also confirm that I/we am/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this form and I/we complete this form on their behalf.
Any other comments, requests or relevant information you need to add:
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss quote details in person. Please leave a contact phone number and best time to call to facilitate this.
Your full name:
Company/Business/Name of Applicant to be Insured:
ABN:
Your phone number (please include area code):
Your mobile phone number:
Best time(s) to call:
Please send my quote by (select at least one):
email phone fax mail
Your email address:
Your website address:
Your fax number:
Your postal address:
Country: