AVIATION INSURANCE PROPOSAL/KYC FORM-1

IMPORTANT

An Insurance Agent who assists an applicant to complete an application or proposal form for insurance shall be deemed to have done so as the agent of the applicant – Section 54 (2) Insurance Act 2003.Please answer ALL questions in full. Use CAPITAL LETTERS.

DETAILS OF PROPOSER

Name of Proposer:

Address:

Name of Aircraft to be Insured:

Passenger Seating Capacity:

Engine Number and Type:

Type of Aircraft and Serial Number:

Year of Construction:

Licensed Seating Capacity:

Registration/Identification Marks:

Value of Extra Equipment:

Number of Aircraft:

Place of Purchase:

Price Paid:

Present Value:

Value of Extra Equipment & Accessories:

Total Value of Aircraft:

Aircraft Flying Destinations:

Geographical Limits of Aircraft:

Location of Maintenance:

Aircraft Parking Locations:

Does the Aircraft Make Use of a Hanger? Yes
No

State Construction Type of Hanger:

Frequency of Use:

No. of Hours Flown Till Date:

State Details of All Accidents, Losses During the Last Five Years:

Name of Captain/Assistant:

Age:

Type of Aircraft Flown:

Current License Number:

Current License Expiry Date:

Flying Experience:

Total Nights: