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Aircraft Insurance

GSIS bond insurance application form for aircraft

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GOVERNMENT SERVICE IN8URANCB 8VaTQII

GENERAL iNIURANCI GROUP'
RUlB'I Bwd., Pa.IV Clty
Tel. ND. 891-6181 ht~ 4283 aroU11: Tetlm No. 551-1218

AIRCRAFT INSURANCE APPLICATION
NNwtE OF APPLICANT

: ~DRESS

OF APPUCANT

YEM OF ~UFACTURE

M64
REGISTRATfON NO.

PERIOD OF COVER:
From:

0001 hr

2400 hrs

To

NO. OF SEATS

NO. OF CRBN ~_~~
__
(Seating CIIJNIC)i1y fOI pilat, coplots.'~ mec:hlnlCl)

(licensed P•••• n•• r, Se.Ung Ctpadty
eldudlng pllatl, co-plkns, flight mlchantcs)

TERM OF INSURANCE:
VAlUAT~ON~
a) HUll

p-----

b) LlABlLmeS

lltlrd party Liabilly Bodily Iqury
(other the PI.lenger) ...•....~.... P
p _

." ....•...M.......

PropertyDa~p
Lfgall1abllityto

..

any one penon
any Ime ileadent

anyone occurrence

P
P

Pllseng," ..•,'

Iny gne p.slenger

p

•

Plilenger Admitted UabUlty

_

P

anyone

ocCU'l'tInce

any one pal •• nger
IllY Gn_ aCCUlTlnOt

Penonal kc:ide nt
Ptld
Co.plol

P
P -----

Crew member

P

_

P'lOTV'M~TY:

_

Pj'Qh Name & QuaHfication:
Filed WnR

TotalF~g Hours:

_

RotCIf'

Wng

_

Purpou FDrwhich the AlI"CtlIt wilt bt Ulld!
Utl2lzed tme of the
Esthnated

ara-aft an thl

previous }ear

2006 -2007

Utllzation time for ehe eoming ~.r 2001-2008

(]eographlcal Limits;

CERTFIC4TKlN

AS TO

AVALNtIUTY OF fUNDS

_
 
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