HULL AND LIABILITY INSURANCE

Aircraft Proposal Form

Privacy Collection StatementAt Catalyst Aviation Insurance we are committed to protecting your privacy. We use the information

you provide to arrange insurance and to assist with claims handling. We provide your information

to insurers or intermediaries whom we ask to quote for your insurances and to enable them to

decide whether to offer you insurance and if so, on what terms. We also provide the information to

insurers with who we have bound cover or those that act on their behalf.

We do not trade, rent or sell your information. We may disclose your information to recipients in

the United Kingdom for the purpose of arranging the insurance or handling any claims. If a

recipient is not regulated by laws which protect your information in a way that is similar to the

Privacy Act, we will seek your consent before disclosing your information to them.

Your duty of disclosureBefore you enter into an insurance contract, you have a duty to tell us anything that you know, or

could reasonably be expected to know, may affect our decision to insure you and on what terms.

• You have this duty until we agree to insure you.

• You have the same duty before you renew, extend, vary or reinstate an insurance contract.

• You do not need to tell us anything that:

– reduces the risk we insure you for; or

– is common knowledge; or

– we know or should know as an insurer; or

– we waive your duty to tell us about.

If you do not tell us something

If you do not tell us anything you are required to, we may cancel your contract or reduce the

amount we will pay you if you make a claim, or both. If your failure to tell us is fraudulent, we may

refuse to pay a claim and treat the contract as if it never existed.

Catalyst Consulting (Aust) Pty Ltd ACN 114 647 657 ABN 38 337 157 538

Underwriting Agency AFS Licence No. 480086

Trading as Catalyst Aviation Insurance

Tel +61 (3) 9095 7233

PO Box 70, Black Rock Vic 3193

www.catalystaviationinsurance.com.au

2

Name and address of applicant:

Name aircraft to be insured in:

Telephone : E-mail:

Limits Required for Third Party and Passenger Liability:

For each pilot advise:

Full description of aircraft uses i.e. “Private Pleasure”, Special Uses

Aircraft Year of Passenger

Make Model Manufacture Registration Value Seats

Name/ Licence and Total Hours Hours on Hours on

Occupation Age Ratings Flown Type Make and Model

HULL AND LIABILITY INSURANCE | Aircraft Proposal Form

3

Annual utilisation of aircraft (how many hours aircraft being flown per annum) and amount of

hours per use:

Is aircraft financed? If so advise amount and to whom:

Where is aircraft based?

Hangared? In open?

Geographical limits required:

How many years have you owned this aircraft?

When is insurance due?

Claims record last five years advising date of loss, amount paid and brief circumstances of loss

(all pilots and all insureds):

Current insurer:

Signature: Date:

HULL AND LIABILITY INSURANCE | Aircraft Proposal Form