Proposer Details

Name OF INSURED

EMAIL ADDRESS

CONTACT NAME

STREET/AREA

POSTAL TOWN

POST CODE

Contact Number

Renewal Date

Premises Liability Details

Does applicant own or occupy any airport premises? If yes, please list airport name(s

List all buildings, hangars, ramps and all other premises to be insured.

Applicant occupies: All / part of premises and is Owner / Tenant / General lessee of premises

List all vehicles and mobile equipment, such as aircraft tugs and fuel trucks, used on the airport premises.

Describe your main activities

Anticipated revenue from this source of business.

Hangarkeeper Liability Details

Does applicant ever have non-owned aircraft in his care, custody or control at his premises? If yes, please provide the following details

Average value any one aircraft

Average total value at any one time

Maximum value any one aircraft

Maximum value at any time

Maximum value any one hangar

Maximum Value Outside Hangars

Average Number Of Aircraft in your Care, Custody and Control

Details of any Rotor Wing aircraft in the above

Average number of engines in your care, custody and control

Do you require in flight hangarkeepers cover

Anticipated revenue from this source of business

Product Liability Details

Name any Subsidiaries with Aviation Products

Sales Last 12 Months Fixed Wing split Civil/Military

Sales Last 12 Months Rotor Wing split Civil/Military

Total Sales Last 12 Months split Civil/Military

Fuel Sales last 12 months £/litres split civil/miltary

Estimate FW sales next 12 months

Estimate RW sales next 12 months

Estimated Fuel Sales next 12 months £/litres

How long has the insured been in business

Describe main activities (e.g. repair station, paint spray shop, refueller, avionics specialist, engine or propeller shop)

On what aircraft types does the insured normally work?

Does the insured manufacture any aviation products

Does the insured represent any manufacturers of aviation products?

Has the Insured signed any aviation contracts that include additional Insured, hold harmless, waiver of subrogation or indemnity provisions that may affect this insurance?

As far as known has the Insured exposed itself, or, protected itself when signing contracts affecting this insurance?

Does the Insured do any business with customers or agents domiciled in the USA?

Describe the experience and general training levels of Insured's aviation personnel.

Have any claims been made against the Insured during the past 10 years? If so, what were the details and amounts involved?

If previously uninsured, give details of any payments made to claimants.

Does the Insured currently buy aviation products liability coverage? If so, with whom?

All aviation products liability policies contain an aggregate limit of liability. What limit of liability do you require?

Any other information

Summary of Products Liability coverage provided

Bodily Injury or property damage arising out of the possession, use, consumption or handling of any goods or products manufactured, constructed, altered, repaired, serviced, treated, sold, supplied or distributed by the Insured or his employees after such Aviation goods or Aviation products have ceased to be in the possession or under the control of the Insured.
The Products section of this questionnaire is not intended for operations involved in aircraft catering, aircraft refuelling or jet airliners.

Declaration

I hereby declare that by completing and emailing this form to the best of my knowledge and belief, the particulars and answers herein are true and correct and that I have not knowingly withheld any information which would influence the decision of the underwriters in regard to this proposal. It is understood and agreed that this proposal shall form the basis of the contract should this policy be issued.

Proposer Details

Premises Liability Details

Hangarkeeper Liability Details

Product Liability Details

Summary of Products Liability coverage provided

Insurance

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