AIRCRAFT FORM Aviation Form APPLICANT DETAILS First name Last name Street Adress Street Adress Street Adress Street Adress City City Province Province Postal Postal Email Telephone no. Business or occupation of insured Current insurer Effective date AIRCRAFT DETAILS Aircraft Registration Passenger seats (excluding pilot) Manufacturer (ex.: Bombardier) Model (ex.: Global 7000) Year Wheel value ($) Ski value ($) Float value ($) Amphibian ($) PILOT DETAILS First name Last name Age Total flying time Total time - Floats Total time - Taildragger Total time - Multi-Engine PIC Total time - Retractable Total flying time - Last 12 months Total time on aircraft stated above Licence type Recreational Private Commercial Licence number Endorsements to Licence Add a pilot Remove pilot Have no accidents or violations in the last 5 years Accident / violations in the last 5 years (explain) : Section Please leave this blank Send
