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Aviation Questionnaire: Your Details

This aviation questionnaire collects information from individuals who fly or participate in similar activities to assess if they can be offered insurance coverage and the terms of that coverage. It asks for details about hours flown in different aircraft over the last and next 12 months, purposes of flying, licenses held, and club memberships. The applicant must provide honest and accurate information as incorrectly answering questions could result in canceled coverage, changed terms, or denied claims.

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42 views3 pages

Aviation Questionnaire: Your Details

This aviation questionnaire collects information from individuals who fly or participate in similar activities to assess if they can be offered insurance coverage and the terms of that coverage. It asks for details about hours flown in different aircraft over the last and next 12 months, purposes of flying, licenses held, and club memberships. The applicant must provide honest and accurate information as incorrectly answering questions could result in canceled coverage, changed terms, or denied claims.

Uploaded by

ahmed4dodi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Aviation questionnaire

Your details
Name

Application number(s)

Why we are asking you for this information


You told us that you fly or take part in a similar activity. We’d like some more information on this so that we can assess whether to offer you
cover and the terms of that cover.
If you also fly as part of the armed forces, please complete the armed forces questionnaire in addition to this one.

What you need to know before completing the questionnaire


You must take reasonable care to answer the questions fully, honestly, and accurately, to the best of your knowledge.
If you don’t answer the questions correctly your policy may be cancelled, or its terms may be changed, or your claim may be rejected or not
fully paid.

Please answer the following questions


1 Please state hours flown as pilot, aircrew or passenger Last 12 months Expected next 12 months
(as applicable) in: As pilot or aircrew As passenger As pilot or aircrew As passenger

a) Company owned aeroplanes (used for business purposes)

b) Company owned helicopters (used for business purposes)

c) Privately owned aeroplanes (not company or club owned)

d) Privately owned helicopters (not company or club owned)

e) Club aircraft (as a club member)

f) Club aircraft (not as a club member)

g) Gliders (self launch)

h) Gliders (unpowered)

i) Hot air balloons

j) Hang gliders (self launch)

k) Powered hang gliders

l) Microlights
2 Do you fly for any of the following purposes?
a) Airworthiness testing  Yes    No
b) Experimental or prototype testing  Yes    No
c) Crop dusting  Yes    No
d) ‘Air taxi’ operation  Yes    No
e) Air shows, demonstrations, competitions or any record breaking attempts  Yes    No
If you have answered ‘yes’ to any of the questions above please give details below, including a statement of hours
usually flown per annum for the relevant purpose(s):

3 Do you participate in:  Total number of jumps


per annum

a) Parachuting  Yes    No


b) Skydiving  Yes    No


c) Base jumping  Yes    No


4 For fixed and rotary wing aviation (private or club) please confirm your total solo flying experience, in hours:

5 Do you belong to any aviation club or association?  Yes    No


If ‘yes’, please give details below:

6 If employed as pilot or aircrew, please confirm your employer’s name and British Air Operator Certificate type:

7 Please give details of licences held, e.g. private pilot, commercial pilot, student pilot, ATPL, night flying, radio telephony:

8 If your flying activities have not been illustrated through the above questions, please detail the activities here:
Declaration
I declare that:
• I have completed the information on this form fully, honestly, and accurately, to the best of my knowledge.
• I am aware that if I haven’t answered the questions correctly my policy may be cancelled, or its terms may be changed, or a claim may be
rejected or not fully paid. Cancelling a policy means that no cover or other benefits will be provided.
• I have read and understood the declaration in the application, and I consent to my personal data being used in the way described in the
Data Protection declaration and the leaflet ‘Your privacy is important to us’.

Signature


Date
 
D D M M Y Y Y Y

Zurich Assurance Ltd, authorised by the Prudential Regulation Authority and regulated
by the Financial Conduct Authority and the Prudential Regulation Authority.
Registered in England and Wales under company number 02456671.
Registered Office: The Grange, Bishops Cleeve, Cheltenham, GL52 8XX.
Telephone: 01793 514514
We may record or monitor calls to improve our service.

NP720785001 (02/18) RRD

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