579 Kingston Road West
Ajax, ON   L1S 6M1
( 905 ) 683-8986
( 800 ) 463-0754
bill@jsdavidson.ca
 



National Aviation
Insurance Brokers
579 Kingston Rd. W
Ajax, ON   L1S 6M1

phone: ( 905 ) 683-8986
toll free: ( 800 ) 463-0754
fax: ( 905 ) 683-6977

info@natlaviation.com


Private





Please provide as much detail as possible to ensure accuracy!
Name of Insured:
Street Address:
City or Town:
Province:
Postal Code:
Telephone:
Fax:
Email:
Business or Occupation Insured:
Current Insurer:
Expiry Date:

Aircraft Details:
Aircraft Registration:
Year:
Make & Model:
Passenger seats excluding pilot:
Value Wheels $:
Value Skis $:
Value Floats $:
Value Amphibian $:
If aircraft is operated in more than one of these configurations a value must be stated for each configuration!

Aircraft is usually based at:

    Hangared:
    Tied Down:
    Moored:

Use of Aircraft:     Pleasure & Business:     Rental:     Instruction:     Other:

Pilots: Pilot #1 Pilot #2
Name
Age
Total Flying Time
Total Flying Time ( last 12 months )
Total time on this Aircraft
Total time on Floats
Total time Taildragger
Total multi engine PIC time
Total retractable time
License type and number
Endorsements to licence
Accidents ( last 5 years )

Provide extended details regarding the above above:

Coverage Required:
Hull - All risks flight and ground     All risks ground including taxying     All risks ground excluding taxying  
Liability $1,000,000 BI/PD Bodily Injury Property Damage Excluding passengers
$1,000,000 BI/PD Excluding passengers PLUS $100,000 Passenger Legal Liability ( PLL )
$1,000,000 BI/PD/PLL ( no passenger sub limit )



© 2002 WebDBX.COM Inc, JS Davidson Insurance Brokers Limited All rights reserved webmaster Last updated on Friday March 12, 2004