Quote: balloons fleet

Identification of the applicant
Company name *
Address *
Phone
Fax
E-mail *
Ballons basés sous hangar/garage :
Par qui est réalisé l’entretien des ballons :
Quel est le niveau d’agrément de l’atelier d’entretien :
Geographical limits
  France only
  Europe only
  Europe and countries bordering the Mediterranean only
  Others
If others (complet below)
Insurance history
Has the applicant been insured during the last 5 years
If yes
With which insurance company(ies)
Through which intermediary(ies) (agent / broker)
Annual contract renewal date
Le proposant a-t-il fait l’objet d’une résiliation de contrat :
If yes, what was the reason
Accidents involving the applicant in the past five years
(balloons, dates, circumstances, results, cost)
Balloons and pilots fleet
Clause
Number of balloons
Balloon 1
Make
Type
Registration number
Date of manufacture
Number of pilot seats
Number of passenger seats
Volume in m3
Maximum take-off weight in kg
Private leasure flights
Business passenger flights
with tickets
Largage de delta plane
Largage de parachutistes
Ecole avec largage solo
Others
Pilot 1
Name and surname
Date of birth
Date of licence
IFR qualification currently valid
Instructor
Number of flying hours
Specific experience
Coverage needed
Legal Liability Capital desired in € including cover for war risks, terrorism and allied perils (AVN52E)
Hull ordinary risks
Aircraft value
Personal Accident Capital desired in € ( (Death and Permanent Disability)
Number of pilot seats to be insured
Number of passenger seats to be insured
Ground Legal Liability
Balloon 2
Make
Type
Registration number
Date of manufacture
Number of pilot seats
Number of passenger seats
Volume in m3
Maximum take-off weight in kg
Private leasure flights
Business passengers flight
with tickets
Largage de delta plane
Largage de parachutistes
Ecole avec largage solo
Other(s)
Pilot 2
Name and surname
Date of birth
Date of licence
IFR qualification currently valid
Instructor
Number of flying hours
Specific experience
Coverage needed
Legal liability Capital desired in €including cover for war risks, terrorism and allied perils (AVN52E)
Hull ordinary risks
Aircraft value
Personal Accident Capital desired in € ( (Death and Permanent Disability)
Number of pilot seats to be insured
Number of passenger seats to be insured
Ground Legal Liability
Balloon 3
Make
Type
Registration number
Date of manufacture
Number of pilot seats
Number of passenger seats
Volume in m3
Maximum take-off weight in kg
Privat leasure flights
Business passenger flights
with tickets
Largage de delta plane
Largage de parachutistes
Ecole avec largage solo
Other(s)
Pilot 3
Name and surname
Date of birth
Date of licence
IFR qualification currently valid
Instructor
Number of flight hours
Specific experience
Coverage needed
Legal Liability Capital desired in € including cover for war risks, terrorism and allied perils (AVN52E)
Hull ordinary risks
Aircraft value
Personal Accident Capital desired in € ( (Death and Permanent Disability)
Number of Pilot seats to be insured
Number of Passenger seats to be insured
Ground Legal Liability
Balloon 4
Make
Type
Registration number
Date of manufacture
Number of pilot seats
Number of passenger seats
Volume in m3
Maximum take-off weight in kg
Private leasure flights
Business Passenger flights
with tickets
Largage de delta plane
Largage de parachutistes
Ecole avec largage solo
Other(s)
Pilot 4
Name and surname
Date of birth
Date of licence
IFR qualification currently valid
Instructor
Number of flying hours
specific experience
coverage needed
Legal Liability Capital desired in € including cover for war risks, terrorism and allied perils (AVN52E)
Hull ordinary risks
Aircraft value
Personal Accident Capital desired in € ( (Death and Permanent Disability)
Number of pilot seats to be insured
Number of passenger seats to be insured
Ground Legal Liability
Balloon 5
Make
Type
Registration number
Date of manufacture
Number of Pilot seats
Number of Passenger seats
Volume in m3
Maximum take-off weight in kg
Privat leasure flights
Business Passenger flights
with tickets
Largage de delta plane
Largage de parachutistes
Ecole avec largage solo
Other (s)
Pilot 5
Name and surname
Date of birth
Date of licence
IFR qualification currently valid
Instructor
Number of flying hours
Specific experience
Coverage needed
Legal Liability Capital desired in € including cover for war risks, terrorism and allied perils (AVN52E)
Hull ordinary risks
Aircraft value
Personal Accident Capital desired in € ( (Death and Permanent Disability)
Number of Pilot seats to be insured
Number of Passenger seats to be insured
Ground Leal Liability
Balloon 6
Make
Type
Registration number
Date of manufacture
Number of Pilot seats
Number of Passenger seats
Volume in m3
Maximum take-off weight in kg
Private leasure flights
Business Passenger flights
with tickets
Largage de delta plane
Largage de parachutistes
Ecole avec largage solo
Other(s)
Pilot 6
Name and surname
Date of birth
Date of licence
IFR qualification currently valid
Instructor
Number of flying hours
Specific experience
Coverage needed
Legal Liability Capital desired in € including cover for war risks, terrorism and allied perils (AVN52E)
Hull ordinary risks
Aircraft value
Personal Accident Capital desired in € ( (Death and Permanent Disability)
Number of Pilot seats to be insured
Number of Passenger seats to be insured
Ground Legal Liability
Various
Payment method
How did you find us?
Specify
Date of inception
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Quote: balloons fleet