Aviation Premise & Hangar Keepers Liability Insurance Form
Insured Details
Insured Name
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number
Email
example@example.com
Name of Airport/Premises
Is the insured the owner and/or operator of the airport(s)?
Yes
No
Describe the nature of the insured's aviation-related business:
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Period of cover required:
12 months starting on:
January
February
March
April
May
June
July
August
September
October
November
December
2019
What limits and liability are required for:
Aviation Premises Liability
Hangers Keepers Liability
Aviation Premises Liability
Location of Premises:
Largest Aircraft using the airport:
Number of employees working for the insured:
Number and Type of vehicles airside:
Hangars Keepers Liability
Number of hangars and aircraft capacity:
Maximum value of any one aircraft:
Maximum value of aircraft in any one hangar:
Do you carry out test flights?
Yes
No
N/A
If Yes, please state the number of flying hours per annum and provide details of pilot(s) experience, including number of hours on type,Flying hours per annum, Pilot(s) experience:
Do you perform any engine-running / bench testing?
Yes
No
N/A
If yes, please provide the estimated number of hours per annum:
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Loss History
If previously insured, please give details of any paid and outstanding claims in the last 5 years or if not previously insured please give any incidents which may have given a rise to claim:
Miscellaneous
Has any insurance company or any underwriter ever in connection with any aviation liability insurance:
Declined your proposal?
Yes
No
N/A
Refused to renew your policy?
Yes
No
N/A
Cancelled your renewal?
Yes
No
N/A
Required an increase premium or imposed any special conditions at any time?
Yes
No
N/A
If the answer to any of the above is "YES", please provide full details:
Submit
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