Presentation
Policyholder/Insured
Aircraft to be insured
Uses and pilots
Desired Coverage
Validation
AIRCRAFT RISK FORM online
You want aircraft insurance with better guarantees at the best price. We offer tailor-made insurance cover :
Liability (for damages incurred by passengers and third parties)
Hull insurance (for damages incurred by your aircraft)
Personal accident insurance for bodily injury suffered by the pilot (cover afforded to a named pilot or the pilot seat, depending on your choice).
Please fill in the following form and we will send you our best quote as soon as possible.
If it is a Rotor Wing aircraft : Please fill in
questionnaire spécifique HELICOPTERE
.
If it is a balloon: Please fill in
questionnaire spécifique MONTGOLFIERE
.
Information with * must be provided.
Policyholder/Insured
if (addemptyline) {
*Civility
}
Mister
Ms
Company/ Association
if (addemptyline) {
*Country
}
France
Afghanistan
Afrique_du_Sud
Albanie
Algerie
Allemagne
Andorre
Angola
Anguilla
Antarctique
Antigua_et_Barbuda
Antilles_neerlandaises
Arabie_saoudite
Argentine
Armenie
Aruba
Australie
Autriche
Azerbaidjan
Bahamas
Bahrein
Bangladesh
Barbade
Belau
Belgique
Belize
Benin
Bermudes
Bhoutan
Bielorussie
Birmanie
Bolivie
Bosnie_Herzegovine
Botswana
Bresil
Brunei
Bulgarie
Burkina_Faso
Burundi
Cambodge
Cameroun
Canada
Cap_Vert
Chili
Chine
Chypre
Colombie
Comores
Congo
Coree_du_Nord
Coree_du_Sud
Costa_Rica
Cote_d'Ivoire
Croatie
Cuba
Danemark
Djibouti
Dominique
Egypte
Emirats_arabes_unis
Equateur
Erythree
Espagne
Estonie
Etats_Unis
Ethiopie
Finlande
Gabon
Gambie
Georgie
Ghana
Gibraltar
Grece
Grenade
Groenland
Guadeloupe
Guam
Guatemala
Guinee
Guinee_equatoriale
Guinee_Bissao
Guyana
Guyane_francaise
Haiti
Honduras
Hong_Kong
Hongrie
Ile_Bouvet
Ile_Christmas
Ile_Norfolk
Iles_Cayman
Iles_Cook
Iles_des_Cocos__Keeling_
Iles_Falkland
Iles_Feroe
Iles_Fidji
Iles_Heard_et_McDonald
Iles_Marshall
Iles_Pitcairn
Iles_Salomon
Iles_Svalbard_et_Jan_Mayen
Iles_Turks_et_Caicos
Iles_Vierges_americaines
Iles_Vierges_britanniques
Inde
Indonesie
Iran
Iraq
Irlande
Islande
Israël
Italie
Jamaique
Japon
Jordanie
Kazakhstan
Kenya
Kirghizistan
Kiribati
Koweit
Laos
Lesotho
Lettonie
Liban
Liberia
Libye
Liechtenstein
Lituanie
Luxembourg
Macao
Madagascar
Malaisie
Malawi
Maldives
Mali
Malte
Mariannes_du_Nord
Maroc
Martinique
Maurice
Mauritanie
Mayotte
Mexique
Micronesie
Moldavie
Monaco
Mongolie
Montserrat
Mozambique
Namibie
Nauru
Nepal
Nicaragua
Niger
Nigeria
Nioue
Norvege
Nouvelle_Caledonie
Nouvelle_Zelande
Oman
Ouganda
Ouzbekistan
Pakistan
Panama
Papouasie_Nouvelle_Guinee
Paraguay
Pays_Bas
Perou
Philippines
Pologne
Polynesie_francaise
Porto_Rico
Portugal
Qatar
Republique_centrafricaine
Rep_dem_du_Congo
Republique_dominicaine
Republique_tcheque
Reunion
Roumanie
Royaume_Uni
Russie
Rwanda
Sahara_occidental
Saint_Christophe_et_Nieves
Sainte_Helene
Sainte_Lucie
Saint_Marin
Saint_Pierre_et_Miquelon
Saint_Siege
St_Vincent_et_les_Grenadines
Salvador
Samoa
Samoa_americaines
Sao_Tome_et_Principe
Senegal
Seychelles
Sierra_Leone
Singapour
Slovaquie
Slovenie
Somalie
Soudan
Sri_Lanka
Suede
Suisse
Suriname
Swaziland
Syrie
Tadjikistan
Taiwan
Tanzanie
Tchad
Terres_australes_francaises
Thailande
Timor_Oriental
Togo
Tokelaou
Tonga
Trinite_et_Tobago
Tunisie
Turkmenistan
Turquie
Tuvalu
Ukraine
Uruguay
Vanuatu
Venezuela
Viet_Nam
Wallis_et_Futuna
Yemen
Yougoslavie
Zambie
Zimbabwe
@
*
Are you a member of an Association/Federation ?
Yes
No
*
Are you a politically exposed person (PEP) or a member of the famlily of a Politically Exposed Person (PEP*) ?
Yes
No
Aircraft to be insured
if (addemptyline) {
*Aircraft category
}
Fixed Wing microlight
Flex Wing microlight
Gyrocopter microlight
Rotor Wing microlight
CDN aircraft of less than 30 years
CDN aircraft of over 30 years
Aircraft CDNR - without type certificate
Homebuilt aircraft
Vintage aircraft
Homebuilt aircraft
Glider CDN
Glider CNRA
Powered paraglider
Other (please specify)
if (addemptyline) {
*Seating capacity
}
Single seat
Two-seat aircraft
Three-seat aircraft
Four-seat aircraft
5 seats
6 seats
Over 6 seats, please specify
*
Number of pilot(s) seat(s)
*
Number of passenger(s) seat(s)
Number of crew seat
Can the aircraft be flown in dual?
Yes
No
*
Manufacturing year
Is your aircraft fitted with:
*
Floats:
Yes
No
*
Rescue parachute:
Yes
No
*
APIBOX Flight recorder :
Yes
No
*
ALIR BERINGER braking system:
Yes
No
Where is your aircraft based?
*
Is it parked in an enclosed and covered hangar?
Yes
No
Si OUI, est-ce que vous êtes le propriétaire du hangar ?
Yes
No
*
Have you waived any subrogation right against the hangar owner ?
Yes
No
Past insurances:
*
Is your aircraft currently insured?
Yes
No
*
Have any of your insurance policies already been cancelled by one of your previous insurer(s) ?
Yes
No
Préciser la raison
*
Desired inception date- 12 months from:
Uses and pilots
PILOTS :
*
Desired pilot clause:
if (addemptyline) {
Choisissez
}
A/ Named pilots only: to fulfill below
B/ Open pilot warranty
C/ Any pilot/students pilots
A/ Named Pilot clause(Name, Licence and qualifications, total flyoing time, flying time on type and on make and modell)
B ou C/ Open Pilot Warranty
USES:
Please clearly describe every uses of the aircaft (subject to compliance with regulations in force, including for overflown countries)
Any use which has not been listed will not be covered.
Private and pleasure flights
Business flights
Renewal of qualifications, Qualifications
Mountain / Take off from and/or landing to Altiport, Altisurface or glacier
Aerobatic flights
Participation to meetings/airshows
Paid first-flights
Flight-sharing (co-avionnage)
Banner towing / advertising streamer
Glider towing
Aerial photography
Aerial work
Flying schools
CLUB uses, as per status
Aerial work
Parachute dropping
Dry lease for private use
Dry lease for other uses
Commercial use (public passenger transport)
Cargo flight
Evacuation and rescue
Test flights / prototype
test flight/ control after repairs or maintenance
Ferry flights
Other uses or any comments:
CLAISM RECORDS/ INFRINGMENTS(in the past 5 years) :
*
Have you suffered any loss/infringements in the past 5 years? (You being the owner, operator, aircraft, pilot, tenant, student, instructor )
Yes
No
Préciser : Qui / Date sinistre ou infraction / Circonstances / Montant paiement
Desired Coverage
Please indicate below which coverage you would like to get:
Attention; should you take out the policy, the only coverage mentionned in the policy will apply
*
Third Party Liability Insurance (TP)
Yes
No
Avez-vous souscrit l'assurance RC via une fédération ?
Yes
No
*
Hull Ground risks only (whilst the engine is not in motion)
Yes
No
*
Hull full flying risks
Yes
No
*
Personal Accident - Pilot Seat
Yes
No
Montant du capital souhait¨¦ en cas de DECES / INVALIDITE PERMANENTE
*
Road transportation of the aircraft
Yes
No
*
Repatriation
Yes
No
Submit
Cancel
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