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):
 

[  ] A. - Is the flying of the aircraft restricted to certain named pilots? If so please give the following information:-

 

Name of Pilot

Type of License

Total Hours

Hours on Type

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[  ] 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:

 

8.   MAINTENANCE DETAILS

1.       Who will carry out Routine Maintenance?

2.      Who will carry out Major Overhauls?

 

9.   LOSS RECORD - Please give details of any Losses/Claims/Incidents or Violations of either the Insured, the Operator or any named Pilots. (Please note – failure to give accurate information may lead to claims being denied by Underwriters).

 

 

10.   SIGNED: _______________________________  DATE: _____________________