Aircraft Insurance Quotation Request Form

Please complete this form and we shall provide you with a quotation.

The more information that you provide to us will mean that we can select the most suitable Underwriters  for your 
enquiry.      Please remember that you must give true and full answers to ensure that you are fully protected in the 
event of the claim and that Underwriters quotation is correct.        If you do not provide accurate information then 
an insurance policy arranged on the basis of the information you have supplied may not protect you in the event 
of a claim

Surname                                                                   	  
First Name (s)                                             
Group Name (if applicable)                       

 Address                                        
                                                         
                                                    
                                                    
                                                     
Postcode                                                 
Country                                           

Home Telephone                                        
Work Telephone                                        
Fax                                                                
Email Address                                            

Aircraft Type                                              
Manufacturer                                             
Model                                                          
Registration                                                
Year                                                              
Number of Passenger Seats                      
Value to be Insured                                    GBP £USD $Euro NZD $ 
Value of any Trailer                                    GBP £USD $EuroNZD $ 

Where is the Aircraft Based                    
Where is it stored                                      HangaredTied Down in the OpenIn the openKept in Own Trailer

Estimated annual utilisation                    

Please select use                                       Private Pleasure Business (Standard Use)Private Pleasure Business + Ab-initio instruction of named pilotsPrivate Pleasure Business Plus Rental to Pilots in excess of 150 hours total timePrivate Pleasure Business Plus Rental to Pilots in excess of 100 hours total timePrivate Pleasure Business Plus Rental to Pilots with a valid licenceFull Club Uses (including Rental & Ab-initio instruction of unnamed pilots)

In order that we can advise on the suitable  level of Third Party and Passenger cover please :

Specify the maximum take off mass of the aircraft       UnknownUp to 499kg500 - 999 kg1,000 - 2,699 kg2,700 - 5,999 kg

European Airspace Based Aircraft - Do you require a limit greater  than the EU Minimum ?  NoYesUnsure  If so, please specify amount Not ApplicableGBP £USD $EuroNZD $ 

Please tick if you require the following compulsory liability limits to be included :        Crown (MOD)      German Liability        Danish Liability

Non European Airspace Based Aircraft - Please advise Third Party / Passenger Liability Limits required Not ApplicableNZD $USD $  


Pilot 1
Pilot Name                                                              
Age / Date of Birth                                               
Total Flying Hours Logged                                
Total Logged Single engine fixed wing hours 
Total Logged Flex-wing hours                           
Hours Logged on make & model                         "make & model" means  make & model 
                                                                                                                                                             of  the Aircraft to be Insured
Hours on Tricycle / Tailwheel                             TricycleTailwheelTricycle / Tailwheel
Type of Licence Held                                          PPLNPPLATPLStudent        If other(s) please specify 


Pilot 2
Pilot Name                                                              
Age / Date of Birth                                               
Total Flying Hours Logged                                
Total Logged Single engine fixed wing hours 
Total Logged Flex-wing hours                           
Hours Logged on make & model                         "make & model" means  make & model 
                                                                                                                                                             of  the Aircraft to be Insured
Hours on Tricycle / Tailwheel                             TricycleTailwheelTricycle / Tailwheel
Type of Licence Held                                          PPLNPPLATPLStudent        If other(s) please specify 


Pilot 3
Pilot Name                                                              
Age / Date of Birth                                               
Total Flying Hours Logged                                
Total Logged Single engine fixed wing hours 
Total Logged Flex-wing hours                           
Hours Logged on make & model                         "make & model" means  make & model 
                                                                                                                                                             of  the Aircraft to be Insured
Hours on Tricycle / Tailwheel                             TricycleTailwheelTricycle / Tailwheel
Type of Licence Held                                          PPLNPPLATPLStudent        If other(s) please specify 


Pilot 4
Pilot Name                                                              
Age / Date of Birth                                               
Total Flying Hours Logged                                
Total Logged Single engine fixed wing hours 
Total Logged Flex-wing hours                           
Hours Logged on make & model                         "make & model" means  make & model 
                                                                                                                                                             of  the Aircraft to be Insured
Hours on Tricycle / Tailwheel                             TricycleTailwheelTricycle / Tailwheel
Type of Licence Held                                          PPLNPPLATPLStudent        If other(s) please specify 


Pilot 5
Pilot Name                                                              
Age / Date of Birth                                               
Total Flying Hours Logged                                
Total Logged Single engine fixed wing hours 
Total Logged Flex-wing hours                           
Hours Logged on make & model                         "make & model" means  make & model 
                                                                                                                                                             of  the Aircraft to be Insured
Hours on Tricycle / Tailwheel                             TricycleTailwheelTricycle / Tailwheel
Type of Licence Held                                          PPLNPPLATPLStudent        If other(s) please specify 


The Basic cover provided an operating area of the United Kingdom and Europe which will be more fully defined 
when we obtain underwriters terms and provide them to you.        If you require cover outside of these standard 
limits then please provide details at the bottom of this form.


Name of Current Broker                                      
Name of Current Insurer / Underwriter             
Renewal Date                                                       
Last Year's Premium                                            
Number of Years with Current Broker              


If you have any other information that is relevant then please enter it in the space below:
(For example this should include any Accident/Claim/Loss History (as pilot or owner) during the last three years  for anyone who will use the Aircraft)

NPPL Holders - You should also specify any medical conditions that any NPPL  pilot has that would preclude the issue of a class 2 JAR Medical



You should disclose any facts that may influence the acceptance of the insurance otherwise you may not be 
covered in the event of a claim.

Please check that all the information that you have given is, to the best of your knowledge, true and accurate.  
Please then submit this form.

Important : If you do not see the Thank You message after submitting the form then it has not worked and your
browser is not compatible - please then email the information to us on info@traffords-insurance.co.uk