New Aircraft Application

Please complete the form below to obtain a Glider Insurance Quotation.

Upon completion of the form, please click the Submit Button.

We suggest you print a copy of your form before submitting for your records.

We will then process the request and respond to you via email with a premium quotation.

Please note, no coverage can be bound without receipt of written confirmation from Gallagher and the issuance of a Certificate of Insurance specific to your Glider.

General Information

Requested Add Date:

Current Member of SAC:

SAC Club:

Aircraft Registration:

Aircraft Year of Manufacture:

Aircraft Make and Model:

Motor Glider:

Is Aircraft Leased:

Who is the Aircraft Renter/Lessor:

Aircraft Owner(s):

Aircraft Owner Address:

Phone Number:

Email:

FLARM Information

FLARM Serial Number:

Aircraft Coverage

Aircraft Hull Value:

Liability Coverage:

Aircraft Type:

Trailer Physical Damage:

Claims Information

Claims Declaration:

Details of Claims:

Pilot Information

Pilot 1

Pilot Name:

PIC Total Gliding Hours:

PIC Total Gliding Hours in Last 12 Months:

Pilot 2

Pilot Name:

PIC Total Gliding Hours:

PIC Total Gliding Hours in Last 12 Months:

Pilot 3

Pilot Name:

PIC Total Gliding Hours:

PIC Total Gliding Hours in Last 12 Months:

Please note that you must be a paid up member of SAC for the insurance to be validated.

Errors and Omissions Excluded. Please refer to the actual Policy Document for full Terms and Conditions.