AIR TRAFFIC CONTROL LIABILITY INSURANCE FORM

AIR TRAFFIC CONTROL LIABILITY INSURANCE FORM
Client Name
(the policyholder that executes the contract of insurance)
Email
example@example.com
Annual Turnover
What is your annual turnover?
Is your annual turnover in excess of USD1 million?
Is your annual turnover in excess of USD10 million?
Balance Sheet Total
What is your balance sheet total?
(total of all assets without any deduction for liabilities i.e. fixed assets and current assets)
Is your balance sheet total greater than USD5million?
Is your balance sheet total greater than USD10million?
Is your balance sheet total greater than USD10million?
Average number of employees
Is your average number of employees during the coming year greater than 250?
Operations inside the European Economic Area (EEA)
Do you have business operations located in at least one of the following countries?
The EEA: Austria, Belgium, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece,Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands,Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, United Kingdom.

To fulfill our regulatory obligations this section of the Proposal Form must be completed
If insufficient space provided please identify and fill in the provided boxes below.
Name of Insured
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com


How long have you been undertaking ATC operations?
How many Air Traffic Control (ATC) centres do you operate?
Where is each located?


Inception date of insurance to which thisquestionnaire relates?
Provide details of your current insurance
Limit of liability required under the insurance?

FOR EACH ATC CENTRE TO BE INSURED


What is the area of responsibility including which airports?
Does the centre have any responsibility for overflying traffic? If yes provide details of area of responsibility.
At what distance do you assume control of incoming aircraft and relinquish control of outgoing aircraft?
Who takes over ATC when you relinquish control of aircraft?


Is the airspace divided into upper airspace and lower airspace for control purposes?
What flight level is the dividing line between upper and lower airspace?
How many sectors are provided for the control of upper airspace and lower airspace?
How is the military and civil interaction of Air Traffic Control achieved through the control centres?
Are military controllers in the ATC room for liaison purposes? If so under whose authority do they operate?
How many staff are normally on duty at any one time?
How many staff are on duty at busy periods?
What is the normal watchkeeping / shift period?
What is the total number of control officers employed?
State type of radar in use indicating whether this is primary or secondary surveillance radar?
Does the radar provide full coverage over the whole of the area?
Are computers used for Air Traffic Control function? If so, state type of system and how long in use.
Is full overlapping provided for Visual Omni Range Stations currently installed on your airway network?
Are standby VORs provided?
IF APPLICABLE do you control airside vehicular movements? If yes to what extent (the crossing of taxi and runways)? Is this done by the same personnel who control aircraft?


Is standby power available at the VOR site?
What direct user to user telephone service is provided between Air Traffic Control Centres and also between Air Traffic Control Centres and airports within defined areas?
Does the Air Traffic Control Centre have standby power supplies and battery operated emergency lighting?
If applicable is there a full view of the manoeuvring area from the tower?
If applicable is there a full view of the marshalling area from the tower?
Is heating, ventilation and cooling provided in the tower?
Is the tower sound proofed?
Are approach control and aerodrome services provided?
Is radar used for approach control? If so, indicate type and operational cover given
Is radar used for any other use at the airfield?
Is any secondary surveillance radar in use?
Is closed circuit television used for any purpose?
State radio facilities provided
State radio standby services provided
Are the radio / telephone transmissions recorded?
What direct telephone circuits are provided?
Is there direction finding (DF) equipment available?


What procedures are in place to monitor a controller’s performance? How do they compare to that of the CAA / FAA?
What recurrent training do the controllers undergo?
What is the average controller experience?

PLEASE PROVIDE THE FOLLOWING LANDING / TAKE-OFF / OVERFLIGHT STATISTICS – THIS IS VITAL INFORMATION FOR INSURERS.

IN RESPECT OF FLIGHTS OVER WHICH YOU HAVE CONTROL PROVIDE THE FOLLOWING AS APPLICABLE (SPLIT BETWEEN CIVIL AND MILITARY IF APPROPRIATE)

CIVIL

	LAST YEAR	THIS YEAR	NEXT YEAR
Number of Landings per annum
Number of Take-Off’s per annum
Number of Overflights per annum
Estimated total annual revenue

MILITARY

	LAST YEAR	THIS YEAR	NEXT YEAR
Number of Landings per annum
Number of Take-Off’s per annum
Number of Overflights per annum
Estimated total annual revenue

Provide details of any aviation accidents /losses, or claims made against you during the last five years arising from your ATC operations (insured or otherwise) including amount(s) (being) claimed and the claimant(s).This information should include details of losses / claims within any (insurance)deductible.
EXTRA INFORMATION:
Please supply copies of Air Traffic Control Holding and Approach Procedure Charts
Should be Empty: