BERTIL GRIMME (ASIA) LIMITED - GRIMME BUTCHER JONES LIMITED
Aircraft Insurance Questionnaire
Complete this form and email to -- pui6767@yahoo.com
1. INSURED (Full Name and Address):
A.
Where will the aircraft be based (if
different from the above): ______________________________
B. Business of the Insured:
__________________________________________________________
2.
OPERATOR (full
name and address if different from the above).
3.
PERIOD OF INSURANCE -
12 months from: _______________________________________
4.
GEOGRAPHICAL LIMITS
– Please detail normal Geographical Area of operations (identify countries
that can be specifically excluded in these areas).
5.
USES (Please
provide following information):
| A. Uses that you will operate the aircraft for: | Specify | Percentage Split between uses |
| Private, Business and Pleasure: | Yes / No | |
| Commercial Rental: | Yes / No | |
| Beginner Instruction (ab-initio): | Yes / No | |
| Other Instruction: | Yes / No | |
| Specialist Uses (provide details): | Yes / No |
| B. Estimated Utilization of each Aircraft: |
Monthly |
Annual |
6.
PILOTS
- Select A or B (not both):
|
Name of Pilot |
Type of License |
Total Hours |
Hours on Type |
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[ ] B. - If there is to be an “Open Pilot Warranty” please give the minimum qualifications of pilots as follows:-
|
Total Hours |
Hours on Type |
|
| Fixed-wing | ||
| Rotor-wing (piston) | ||
|
Rotor-wing (turbine) |
7.
TYPES OF INSURANCE REQUIRED - Select A or B or C (as you require)
[ ] A. - HULL INSURANCE – Aircraft Details (for each aircraft)
1. Make & Model
2. Registration & Serial Number
3. Agreed Value
4. Year of Manufacture
5.
Number of
Seats --
Crew [
] & Passenger [ ]
[ ] B. - LIABILITY INSURANCE - Third Party/Passenger Legal Liability Limit:
[ ] C. - PERSONAL ACCIDENT INSURANCE:
1. Pilots/Crew Limit:
2. Passenger Limit:
1. Who will carry out Routine Maintenance?
2. Who will carry out Major Overhauls?
10. SIGNED: _______________________________ DATE: _____________________