Presentation
Policyholder/Insured
Aircraft to be insured
Uses and pilots
Desired Coverage
Validation
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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
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*TITLE
Mister
Ms
Company/ Association
*Country
France
Afghanistan
Afrique du Sud
Albanie
Algérie
Allemagne
Andorre
Angola
Anguilla
Antarctique
Antigua-et-Barbuda
Antilles néerlandaises
Arabie saoudite
Argentine
Arménie
Aruba
Australie
Autriche
Azerbaïdjan
Bahamas
Bahreïn
Bangladesh
Barbade
Belau
Belgique
Belize
Bénin
Bermudes
Bhoutan
Biélorussie
Birmanie
Bolivie
Bosnie-Herzégovine
Botswana
Brésil
Brunei
Bulgarie
Burkina Faso
Burundi
Cambodge
Cameroun
Canada
Cap-Vert
Chili
Chine
Chypre
Colombie
Comores
Congo
Corée du Nord
Corée du Sud
Costa Rica
Côte d'Ivoire
Croatie
Cuba
Danemark
Djibouti
Dominique
Égypte
Émirats arabes unis
Équateur
Érythrée
Espagne
Estonie
États-Unis
Éthiopie
Finlande
Gabon
Gambie
Géorgie
Ghana
Gibraltar
Grèce
Grenade
Groenland
Guadeloupe
Guam
Guatemala
Guinée
Guinée équatoriale
Guinée-Bissao
Guyana
Guyane française
Haïti
Honduras
Hong Kong
Hongrie
Ile Bouvet
Ile Christmas
Ile Norfolk
Iles Cayman
Iles Cook
Iles des Cocos (Keeling)
Iles Falkland
Iles Féroé
Iles Fidji
Iles Heard et McDonald
Iles Marshall
Iles Pitcairn
Iles Salomon
Iles Svalbard et Jan Mayen
Iles Turks-et-Caicos
Iles Vierges américaines
Iles Vierges britanniques
Inde
Indonésie
Iran
Iraq
Irlande
Islande
Israël
Italie
Jamaïque
Japon
Jordanie
Kazakhstan
Kenya
Kirghizistan
Kiribati
Koweït
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
Micronésie
Moldavie
Monaco
Mongolie
Montserrat
Mozambique
Namibie
Nauru
Népal
Nicaragua
Niger
Nigeria
Nioué
Norvège
Nouvelle-Calédonie
Nouvelle-Zélande
Oman
Ouganda
Ouzbékistan
Pakistan
Panama
Papouasie-Nouvelle-Guinée
Paraguay
Pays-Bas
Pérou
Philippines
Pologne
Polynésie française
Porto Rico
Portugal
Qatar
République centrafricaine
Rép dém du Congo
République dominicaine
République tchèque
Réunion
Roumanie
Royaume-Uni
Russie
Rwanda
Sahara occidental
Saint-Christophe-et-Niévès
Sainte-Hélène
Sainte-Lucie
Saint-Marin
Saint-Pierre-et-Miquelon
Saint-Siège
St-Vincent-et-les-Grenadines
Salvador
Samoa
Samoa américaines
Sao Tomé-et-Principe
Sénégal
Seychelles
Sierra Leone
Singapour
Slovaquie
Slovénie
Somalie
Soudan
Sri Lanka
Suède
Suisse
Suriname
Swaziland
Syrie
Tadjikistan
Taïwan
Tanzanie
Tchad
Terres australes françaises
Thaïlande
Timor Oriental
Togo
Tokélaou
Tonga
Trinité-et-Tobago
Tunisie
Turkménistan
Turquie
Tuvalu
Ukraine
Uruguay
Vanuatu
Venezuela
Viêt Nam
Wallis-et-Futuna
Yémen
Yougoslavie
Zambie
Zimbabwe
@
*
Are you a member of an Association/Federation ?
Yes
No
*
Are you a politically exposed person (PEP) or a famlily member of a Politically Exposed Person (PEP*) ?
Yes
No
Aircraft to be insured
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*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)
*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
*
AIR BERINGER breaking system:
Yes
No
Where is your aircraft based?
*
Is it parked in a locked and covered hangar?
Yes
No
If so, are you the owner of the 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
Please indicate the reason
*
Requested inception date- 12 months from:
Uses and pilots
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PILOTS :
*
Requested pilot clause:
Choose
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 flying time, flying time on type and on make and model)
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 in meetings/airshows
Remunerated first-flight experiences
Flight-sharing
Banner towing / advertising streamer
Glider towing
Aerial photography
Aerial work
Flying schools
CLUB uses, as per status
Parachute dropping
Dry lease for private use
Dry lease for other uses
Commercial use (public passenger transportation)
Cargo flight
Evacuation and rescue
Test flights / prototype
test flight/ control after repairs or maintenance
Ferry flights
Other uses or any comment:
CLAIMS RECORDS/ INFRINGMENTS(in the past 5 years) :
*
Have you suffered any loss/infringements in the past 5 years? (as a owner, operator, aircraft, pilot, student, instructor )
Yes
No
Specify: Who / Date of loss or infringement / Circumstances / Amount payment
Desired Coverage
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Please indicate below which coverage you would like to get:
IMPORTANT NOTICE : should you take out the policy, you would only be insured for the coverages you have selected below.
*
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
Requested Capital Sum Insured in case of DEATH / PERMANENT DISABLEMENT
*
Road transportation of the aircraft
Yes
No
*
Repatriation
Yes
No
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