Glider – TMG Insurance form

Proposal form GL/TMG (en)

Glider / TMG Insurance Form

Policyholder:

Name of the person who must appear on the insurance.

Company name:

First name:

VAT number:

Last name:

Address:

Email:

Mobil nummer:

Member of:

Membership number:

Insurance renewal:

An offer is usually valid for 1 month only.

Insurance coverage:

Period from:

Period to:

The aircraft:

Registration:

Manufacturer:

Model:

Serial no.:

Year of production:

Max.Takeoff Weight (kilos):

Aircraft type:

Engine type:

Landing gear:

Annual Utilisation in hours:

Is it hangered:

Home base:

Geographical limits:

Hull value:

Currency:

Hull value:

Hull deductible above 1%:

Pilots / Passengers

Named-/ Unnamed pilots:

Min. License to category:

Hour requirements for the pilot:

no. of Pax.

Use(s)

Private and Pleasure

Schooling

Competition flight

Other use:

Claims history:

If there have been any injuries within the last 5 years, they must be described.

Any claims:

Yes

How many clims:

Describe the damage with: date of damage, which insurance (e.g. liability, comprehensive insurance), damage costs and what was damaged:

Previous Contract:

Named pilot(s):

Name:

Date of birth:

Certificat

PIC on model:

PIC on type:

PIC total:

Notes for named pilots:

Notes:

Glider - TMG Insurance form

Policyholder:

Insurance renewal:

An offer is usually valid for 1 month only.

The aircraft:

Hull value:

Pilots / Passengers

Use(s)

Claims history:

If there have been any injuries within the last 5 years, they must be described.

Named pilot(s):

a

Support!

If you have any problems with the form, or would like us to fill it out,
then give us a call.

AGD ApS
Jacob Severins Vej 26
9370 Hals
TLF.: +45 22 23 06 87
e-mail: aviation@aviation.dk

Glider - TMG Insurance form

Policyholder:

Insurance renewal:

An offer is usually valid for 1 month only.

The aircraft:

Hull value:

Pilots / Passengers

Use(s)

Claims history:

If there have been any injuries within the last 5 years, they must be described.

Named pilot(s):

a

Support!

If you have any problems with the form, or would like us to fill it out, then give us a call.

AGD ApS Jacob Severins Vej 26 9370 Hals TLF.: +45 22 23 06 87 e-mail: aviation@aviation.dk

If you have any problems with the form, or would like us to fill it out,
then give us a call.

AGD ApS
Jacob Severins Vej 26
9370 Hals
TLF.: +45 22 23 06 87
e-mail: aviation@aviation.dk