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Civial Aviation Code 009

The document is a questionnaire for the Life Insurance Corporation of India specifically for individuals involved in aviation. It collects detailed information about the proposer’s occupation, flying experience, and specific duties related to aviation. The document also includes a declaration statement confirming the accuracy of the provided information.

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AGASTYA AK (NANI)
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13 views

Civial Aviation Code 009

The document is a questionnaire for the Life Insurance Corporation of India specifically for individuals involved in aviation. It collects detailed information about the proposer’s occupation, flying experience, and specific duties related to aviation. The document also includes a declaration statement confirming the accuracy of the provided information.

Uploaded by

AGASTYA AK (NANI)
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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10

LIFE INSURANCE CORPORATION OF INDIA


AVIATION (CIVIL) QUESTIONNAIRE
( Occupation Code-009)

Proposal No:
Name of the Proposer:

1 Full name of the Employer (please do not use abbreviations)


Department in which you work

Your designation or occupation


Full details of the exact nature of your duties
If you are supervisor, nature or work done
under your supervision
2 Please state whether you fly as a. Commercial Pilot
• Scheduled airline passenger flying
• Flight instructor
• Non-Scheduled passenger flying
• Freight carrying service
• Charter and sightseeing flying
• Aerial photography
• Business flying in Company owned planes
• Crop dusting
• Flying for testing prototype models
• Flying for checking flights of repaired and
new-not prototype-planes
• Any other purpose

b. Non-commercial pilot – pleasure, business, flight instructor,


etc

c. Student Pilot

d. Members of crew of aircraft and other persons flying


in a capacity involving duties aboard an aircraft while
in flight (other than pilots)

e. Members of Ground Staff

f. Passengers flying in aircraft other than scheduled


airline planes
3 Whether you expect your future flying to differ from that done
in the past. If so, give details
4 Particulars of the extent of flying done in the capacity shown under (2) above in the
past and expected to be done in the next twelve months
Period In what capacity No of hours
Current calendar year to date
Last full calendar year
Previous to last full calendar year
All calendar years to date
Estimated for next 12 months
5 The type of aircraft
6 Who owns the aircraft and does the owner hold an Air
Operator’s Certificate?

7 Nature of arrangements for the maintenance and periodical


overhaul of the aircraft
8 Whether the aircrafts are flown only between Government
and public aerodromes? If not, give full details
9 Questions to be answered if you are a pilot
11

a. What type of licence do you hold?


b. Which types of aircraft are you authorized to fly?
c. When did you learn to fly?
d. Have you been involved in any flying accidents? If yes, please give
full details
e. Have you ever had your licence revoked or been grounded? If yes,
please give full details
f. Do you intend to participate in air competitions of any kind, formula
air racing, exhibitions, aerobatics or stunt flying
g. Do you intend to undertake any low-level or specialized flying or
manoeuvring
10 Questions to be answered by test pilots
a. The name of the Flying Club or school where you are receiving
training
b. The flying certificate or licence for which you are undergoing
training
c. Whether you hold any flying certificate or licence?
d. Whether you intend to qualify as a commercial pilot?
11 Questions to be answered by crew members
a. Exact nature of duties on board the aircraft
b. Whether you intend to undergo training as a pilot?
12 Questions to be answered by Ground staff
a. Exact nature of duties
b. Are you required to fly in a capacity involving duties aboard an
aircraft while in flight?
c. Are you required to fly as a passenger?
d. Whether you intend to undergo training as a pilot or member of air
crew? If so, please give details
13 Questions to be answered by passengers flying in aircraft
other than scheduled airline planes
a. Are you a member of an Aeroplane Club?
b. Name of the Club
c. Whether the non-schedule flying done by you is done entirely in
aircraft owned by the Club?
d. Whether you intend to take training as a pilot?

DECLARATION
I ___________________________________________ do hereby declare that the foregoing
statements and answers are true in every particular and agree and declare that these
statements and this declaration along with my Proposal for Insurance and the Declaration
relative thereto shall form the basis of the contract between me and the Life Insurance
Corporation of India and that if any untrue averment be contained therein the said contract
shall be absolutely null and void and moneys which shall have been paid in respect thereof
shall stand forfeited to the Corporation.

Dated at _____________on the _________day of _____________20

Signature of the Life to be assured

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