Quote: Refueller Insurance

This proposal does not concern aircraft leased or loaned to third parties or operated by the insured
Identification of the applicant or the insurer
Name *
Address *
E-mail *
Phone
Registration Company Number
Code APE :
General points
If a company, its Legal Nature and Amount of Share Capital
Number of years in the activity to be insured
Places where aeronautical activities are carried out by the insured
Name of subsidiaries to be insured and other additional insured parties
Name of Company manager responsible for insurance matters
Name of the Company manager responsible for issues of quality and safety
Standard(s) followed by the Company
Insurance
Has the applicant been insured during the last three years for the proposed activity?
If yes, with which company?
Reason for termination / non-renewal
If claims have arisen during the last 5 years, please complete the box below
Date of occurence
Damage
Actual or estimated cost
Also include events that could call into question your liability
Aircraft fuel distribution activities
Aircraft types involved in refuelling
Volume of fuel delivered annually (Litres/Hectolitres/or Gallons): Indiquez Réalisé et Prévisionnel.
100 LL
130-145
JP 1
JP 4
Others
Total
Turnover achieved incl. all taxes
Forecast Turnover
Main customers
Details on the services provided by the Subscriber
Who assumes the responsibilities associated with the storage, transportation and tank-filling operations?
  Insured
  Tanker
  Others
If others (specify)
Is the maintenance of the tanks under Subscriber’s responsibility?
Does the Subscriber conduct aircraft fuel drain operations?
Specify the safety measures taken during refuelling or draining operations
Does the Subscriber perform vehicle refuelling?
If yes, specify the number, type and Characteristics
What are the guarantees attached to these vehicles, as regards damage caused to third parties and aircraft?
Are there underground pipes?
If yes, describe them
Are there self-service points allowing customers to perform refuelling operations including through the use of credit cards?
Is the Company linked by agreements or conventions containing waivers of recourse or transfer of responsibility?
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Quote: Refueller Insurance