CLUB INSURANCE FORM

You wish to cover your CLUB AIRCRAFT FLEET at the best available terms and conditions.

Please fill in the below form. We will get back to you as soon as possible.

Mandatory fields are preceded by an asterisk*

Policyholder/Insured

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* What is your involvment within the Club?

Please indicate your role

* Does your club belong to a Federation/ a sporting group?

Yes No

* Are you a politically exposed person (PEP) or a member of the famlily of a Politically Exposed Person (PEP*) ?

Yes No

Additional information

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* Number of members

* Number of instructors

* How many aircraft do you wish to insure?

Aircraft fleet :

Please specify for every aircraft:
Make/ Model/ Manufacturing year/ Identification or registration/ Seating capacity(pilot seats, passenger seats, crew seats) / MTOW(Maximum Take Off Weight ) / Value of the aircraft (if you are interested by hull insurance) / Owner's name (if non-owned by the Club) / Aircraft category (Homebuilt aircraft, Vintage aircraft, microlight, rotor wing,..)

Uses within the Club: Please clearly describe the aircraft uses (in compliance with Regulation of overflown countries)

Any use not listed will not be covered.

Examples of uses : Private/ Business / Mountain flights / Dry lease / Flying school / Flight-sharing / Remunerated first flights / Aerobatics/ Aerial work / Participation to airshows/meetings, etc...

* Do you rent any of your aircraft?

Yes No

Please specify to whom and for which uses

Other uses or any comments:

Pilot Clause

* Desired pilot clause:

Information regarding pilot for named pilot clause

History

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Losses/ Infringements in the past 5 years:

* Have you suffered any claims/infringements in the past 5 years? (Question applies to the Club, aircraft owner, aircraft operator, pilots, tenants, students instructors and to the aircraft)

Yes No

Please specify who suffered the loss, date, circumstances and cost

Past insurances:

* Is your aircratf fleet currently insured?

Yes No

* Has your policy already been cancelled by an Insurance Company?

Yes No

* Desired policy period- 12 months from: