AIRCRAFT INSURANCE POLICY PROPOSAL FORM

Transcription

1 AIRCRAFT INSURANCE POLICY PROPOSAL FORM (to be used where the UK Insurance Act 2015 applies) (where applicable, required for private owner completion within the meaning of the Consumer Insurance (Disclosure and Representation Act 2012) or similar regulatory requirements) You must take care in answering all the following questions which are relevant to us in providing this insurance and setting the terms and premium. Please contact us if you do not understand the question or the nature of the information required or please seek guidance from your broker. Failure to provide information or the provision of incomplete or inaccurate information may result in loss of cover or other remedies. Proposer s name (in full)... Address... Trade, business or profession: Will your Aircraft be used for purposes wholly or mainly unrelated to your trade, business or profession? DETAILS OF AIRCRAFT TO BE INSURED AIRFRAME Make, Type, Series Number Maximum Take Off Weight (Kg s) Licensed Passenger Seating Capacity Declared Passenger Seating Capacity for the purpose of insurance Registration No. Present Value of Aircraft including Standard Instruments and Equipment Details of Extra Equipment and Accessories, if any Details Value Requested Total Agreed Value for the purpose of insurance Page 1 of 11

2 Please attach a separate sheet if there is insufficient space to answer any of the following questions: Please state fully: 1. The purposes for which the Aircraft will be used (check all that apply): Private Pleasure Business Ab-initio Training Recurrency Instruction Commercial Passenger Commercial Cargo Rental for Private Pleasure and Business Rental for Other Purposes (if Yes provide further information below): Medical Evacuation Commercial Aerial Photography / Filming Aerial Survey Glider Towing Aerobatics (non-competitive) Aerobatics (competitive) Racing Public Airshow and Air Display Other Uses (if Yes provide further information below): Are any of the intended uses noted above for hire or reward? (If Yes provide further information below):.... Page 2 of 11

3 Will the Aircraft be flown at night? 2. Will the Aircraft be used solely in the UK? If No please list the countries where the Aircraft will be used: Does the Aircraft have a valid Certificate of Airworthiness from the aviation authority having relevant jurisdiction over the aircraft? 4. Where will the Aircraft usually be kept? Is this a licensed airfield? Is the Aircraft normally kept in a hangar? If Yes, state construction of hangar below: Have you previously held an aircraft insurance policy? 6. Do you have a current aircraft insurance policy? If Yes, state the name of the insurers below:..... Page 3 of 11

4 7. Within the last 5 years has any insurer of any type of insurance policy: (a) Declined your proposal? If Yes, provide further information below:.. (b) Cancelled or refused to renew your policy? If Yes, provide further information below:.. (c) Required an increased premium or revised terms? If Yes, provide further details below:..... (d) Declined to pay your claim because of an actual or alleged breach of a policy term or condition by you? If Yes, provide further information below: Do you own the Aircraft outright? If No, is it a shared ownership? If so, provide further information below: Page 4 of 11

5 If not owned outright, is there any lease, mortgage or other financial arrangement in effect with any other party in respect of the ownership or operation of the Aircraft? If so, provide further details below:..... Page 5 of 11

6 PLEASE STATE DETAILS OF ALL ACCIDENTS AND/OR LOSSES DURING THE LAST FIVE YEARS Year No. of Aircraft owned and/or operated by Proposer Damage to Aircraft No. of Accidents Cost or Estimate Third Party & Passenger Liability No. of Cost or Accidents Estimate Circumstances of Accidents and/or Losses Page 6 of 11

7 ENTER BELOW DETAILS OF PILOTS WHO WILL FLY THE AIRCRAFT Name Age Types of Aircraft flown and date of last flight Day Flying Hours Night Last 12 months No. Date of Issue Licence Type Is a current medical certificate required to validate this license? Nature and Cause of Accidents or actioned violations of aviation regulations during the last five years Page 7 of 11

8 SECTION 1. ACCIDENTAL DAMAGE: DETAILS OF INSURANCE REQUIRED (Select where applicable) (a) (b) (c) (d) Flight Risks. Taxiing Risks. Ground Risks. Mooring Risks (Waterborne). SECTION 2. THIRD PARTY LEGAL LIABILITY: Limit of Liability any one Occurrence SECTION 3. LEGAL LIABILITY TO PASSENGERS: * Limit of Liability each passenger Limit of Liability each passenger for baggage and personal effects * The Limit of Liability for each Occurrence equals the limit each passenger multiplied by the declared passenger seating capacity of the Aircraft. PERIOD FOR WHICH INSURANCE IS REQUIRED:... On 30 April 2005, EC Regulation EC 785/2004 on insurance requirements for aircraft operators (and air carriers) came into force. The Regulation (as amended) specifies the minimum levels of insurance required in respect of third party cover, passenger cover and cover for risks of war and terrorism. It is your responsibility to keep up to-date with the insurance requirements and to make sure you have the correct insurance cover. Page 8 of 11

9 DECLARATION AND SIGNATURE I/we declare that I/we have made a fair presentation of the risk, by disclosing all material matters which I/we know or ought to know or, failing that, by giving you, the insurer, sufficient information to put a prudent insurer on notice that it needs to make further enquiries in order to reveal material circumstances. I/We will tell you, the insurer if any of the information on this proposal form changes during the period of insurance and I/we understand that if any of the information is not true, or becomes untrue, I/we may not have insurance cover or other remedies under the aircraft insurance policy to which this proposal form relates. Date.. Signature of Proposer(s).. No cover is in force until this proposal is accepted by the insurer and the premium is paid. The insurer reserves the right to decline any insurance proposal or to offer different premium and terms to those quoted dependent on the information you have provided. DATA PROTECTION ACT 1998: Any information you have provided will be dealt with by us in compliance with the provisions of the Data Protection Act For the purpose of providing this Insurance and handling of any claims or complaints which may arise under it, we may need to transfer certain information which you have provided to other parties. By signing this proposal you agree that such transfer(s) may be made. Page 9 of 11

10 REMEDIES FOR BREACH OF THE DUTY OF FAIR PRESENTATION 1. If, prior to entering into this insurance contract, the duty of fair presentation is breached, the remedies available to the insurer are set out below. a) If the breach of the duty of fair presentation is deliberate or reckless: (i) The insurer may avoid the contract, and refuse to pay all claims; and, (ii) The insurer need not return any of the premiums paid. b) If the breach of the duty of fair presentation is not deliberate or reckless, the insurer s remedy shall depend upon what the insurer would have done if there had been compliance with the duty of fair presentation: (i) If the insurer would not have entered into the contract at all, the insurer may avoid the contract and refuse all claims, but must return the premiums paid. (ii) If the insurer would have entered into the contract, but on different terms (other than terms relating to the premium), the contract is to be treated as if it had been entered into on those different terms from the outset, if the insurer so requires. (iii) In addition, if the insurer would have entered into the contract, but would have charged a higher premium, the insurer may reduce proportionately the amount to be paid on a claim (and, if applicable, the amount already paid on prior claims). In those circumstances, the insurer shall pay only X% of what it would otherwise have been required to pay, where X = (premium actually charged/higher premium) x If, prior to entering into a variation to this insurance contract, the duty of fair presentation is breached, the remedies available to the insurer are set out below. a) If the breach of the duty of fair presentation is deliberate or reckless: (i) The insurer may by notice to you treat the contract as having been terminated from the time when the variation was concluded; and, (ii) The insurer need not return any of the premiums paid. b) If the breach of the duty of fair presentation is not deliberate or reckless, the insurer s remedy shall depend upon what the insurer would have done if there had been compliance with the duty of fair presentation: (i) If the insurer would not have agreed to the variation at all, the insurer may treat the contract as if the variation was never made, but must in that event return any extra premium paid. (ii) If the insurer would have agreed to the variation to the contract, but on different terms (other than terms relating to the premium), the variation is to be treated as if it had been entered into on those different terms, if the insurer so requires. (iii) If the insurer would have increased the premium by more than it did or at all, then the insurer may reduce proportionately the amount to be paid on a claim arising out of events after the variation. In those circumstances, the insurer shall pay only X% of what it would otherwise have been required to pay, where X = (premium actually charged/higher premium) x 100. Page 10 of 11

11 (iv) If the insurer would not have reduced the premium as much as it did or at all, then the insurer may reduce proportionately the amount to be paid on a claim arising out of events after the variation. In those circumstances, the insurer shall pay only X% of what it would otherwise have been required to pay, where X = (premium actually charged/reduced total premium) x 100. Nothing herein is intended to vary the position under the Insurance Act AVN 2C Page 11 of 11