YOU’VE REACHED THE AVSURE ON-LINE
AIRCRAFT INSURANCE QUOTATION REQUEST FORM

This page contains a form which will collect the information entered and transmit it to Avsure. If you have an aircraft to insure, continue below.
To enable us to obtain the best quotations, please complete the following fields:- 

BASIC INFORMATION

   1.  Begin by clicking the mouse in the "Aircraft Owner" field, type in your text and then tab from field to field.
   2.  If you have more than one aircraft, more than one pilot, or if there is other pertinent information that this form doesn’t address you can:
                        • Use the "Additional Information" box at the bottom of the page -
                        • E-mail us with the additional information -
                        • Call or fax us at the numbers shown below .
  3.  If you make a mistake, simply re-select the box and type it correctly, or clear the form using the "CLEAR" button below.
  4. Please complete all applicable fields. Completion of the fields with titles in red are required to allow the form to submit.

 

Aircraft Owner: 

Address:              

City:                      

GST Registered?   Yes    No
Operator (if different from  from above):
Lien holder/Financial Interest:

Home Phone (with area codes):

   Bus.Phone (with codes) :

Facsimile (with area codes):

  

Email address:

Expiration date of current policy:
 (indicate if this is a new acquisition)
Would you like your quote: Emailed        Faxed       Phoned

YOUR AIRCRAFT INFORMATION

Registration:

Year:
Make & Model:
Hull Insured Value:
Liability Limits:
Regularly Hangared: Yes    Tied Down?   At:      Airport
 

PILOT INFORMATION
Please provide details as to pilots names, age, qualifications, total flying experience, hours on make and model of machine, turbine hours (if applicable), experience on specific hazardous flying uses; ie.   Agricultural, WAR's, etc., and any other information that may qualify the risk in the eyes of the insurer.

Pilot One           Name:

  Age: Licence(s):    

Instrument Rated?:

 Yes    No

Fixed Wing Hrs: -Total:

On type: Ret.Gear: Multi: T/wheel: Turbine:
Rotary Wing Hrs:-Total: On type: Rotor Turbine: WAR's or Ag:
Accidents/Violations: Any Accidents?   Yes    No      Any Violations?  Yes    No
If 'Yes' to either of above please enter details here - 

Pilot Two           Name:

  Age: License(s):    

Instrument Rated?:

Yes   No

Fixed Wing Hrs: -Total:

On type: Ret.Gear: Multi: T/wheel: Turbine:
Rotary Wing Hrs:-Total: On type: Rotor Turbine: WAR's or Ag:
Accidents/Violations: Any Accidents?   Yes    No      Any Violations?  Yes    No
If 'Yes' to either of above please enter details here - 

Alternatively, you can nominate on an ‘open’ pilot warranty; ie. Pilots as approved by the insured with perhaps restrictions as to licence (ie. PPL or CPL) and/or with minimum requirements to experience; ie. min 100hrs or 200 hrs or 500  hrs., etc., etc.

Subject Pilot Licence:             Minimum Pilot Hours:  

Other (please explain):

Please give precise details. List all forms of flying particularly that involving abnormal hazards; i.e.
Fixed Wing  -  Ab-initio Training, Rental, Parachuting, Towing, Aerobatics, Agricultural.
Rotary Wing - Training, Rental, Slung Loads, Agricultural, WAR's etc
 

Aircraft Use:

 Private, Business and Pleasure:Yes

Loss History:

 Have you ever had an aircraft loss? Yes      No

If 'Yes", provide full details:   

Type additional information/notes/comments here:

THAT’S IT! THANKS FOR YOUR INPUT.

Please check the above information for accuracy. When you’re satisfied with the information you’ve provided, click the "SUBMIT" button below. We’ll get back to you shortly with the best quote available.

In the meantime, if you have any other insurance needs, wish to comment on this Web page or just want to practice your e-mailing skills, feel free to send in your comments to insure@avsure.co.nz

Name of person submitting request:    Title:  

NOTE: This form is not an order to terminate, begin or alter any form of coverage. It is a request for a quote only. It is the duty of the Insured and any Intermediary to disclose all material facts and give a fair presentation of the risk. Insurers may have grounds for avoiding the contract if it transpires that there has been any failure to make such a disclosure. The completion of this questionnaire in no way binds the Proposer to purchase an insurance policy.

AVSURE
(a division of Boston Marks Group Ltd)

Harvard Lane, Ardmore Airport, Papakura, New Zealand

Postal: Private Bag 14, Ardmore Airport, Papakura

Phone: (09) 298-8206   -   Fax: (09) 298-8218   -   Toll Free: 0800 322-206.

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