The fields marked with * are mandatory

Please complete the form below for all new aircraft not currently insured in the SAC Insurance Plan.  Upon completion of the form please click the Submit Button.

We will then process the request and respond to you via e-Mail.

It is recommended to print a copy of the application prior to submitting to retain a copy for your records.

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

Current Member of SAC?: Yes No

Requested Add Date:  

SAC Club: Aero-Club des Cantons ACES Alberni Alberta SC Arthur ASTRA Bonnechere Central Alberta Champlain CuNim Canadian Rockies Edmonton Gatineau Grande Prairie Great Lakes Lethbridge London Montreal Pemberton Prince Albert Quebec Regina Rideau Valley SAGA Saskatoon Silverstar Southern Alberta SOSA Toronto Vancouver Vancouver Island Soaring Western Area Sailplane Winnipeg

Aircraft Registration:

Year of Manufacture:

Aircraft Make & Model:

Motor Glider: No Yes

Aircraft Owner(s):

Is Aircraft Leased?: No Yes

If Yes, who is the Aircraft Renter/Lessor:

Aircraft Owner Address:

Phone Number:

e-Mail Address:

FLARM Information

Flarm Serial Number:

Flarm Date of Purchase:  

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Aircraft Coverage

Aircraft Hull Value:

Liability Coverage: $1,000,000 per occurrence $2,000,000 per occurrence

Aircraft Type: Single Seat Glider w/ Hull Two Seat Glider w/ Hull Single Seat Glider Liab Only Two Seat Glider Liab Only

Trailer Physical Damage: No Yes

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Claims Information

Claims Declaration: No Claims in last 3 years 1 Claim in last 3 years 2 Claims in last 3 years 3+ Claims in last 3 years

Details of Claims:

Pilot Information

All pilots flying P1 will have completed a SAC Annual Spring check: Yes No

1. PILOT NAME:

P1 total gliding hours:

P1 gliding hours within pervious 12 months:

Date of last Spring Check Flight:  

Location of Spring Check Flight:

2. PILOT NAME:

P1 total gliding hours:

P1 gliding hours within pervious 12 months:

Date of last Spring Check Flight:  

Location of Spring Check Flight:

3. PILOT NAME:

P1 total gliding hours:

P1 gliding hours within pervious 12 months:

Date of last Spring Check Flight:  

Location of Spring Check Flight:

:

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