Questionnaire

Your address

Please provide us with the following information: Company: Occupation: Personal information Title:   Mr Mrs First name: Last name: Street: Country: CH DE AT FR IT GB Postal code: City: Telephone: Fax:   E-mail: AAA Member:

Information regarding the aircraft

Please provide us with the following information: Type of aircraft: Glider Powered glider Piston engine aircraft Turbine engine aircraft Helicopter Other Trade-mark and model: Registration n.: Year built: Number of seats

Type of use:

Private   Business/work   Aeroclub   VFR (visual flight rules)   IFR (instrument flight rules)   Approximate number of hours of flight per year:   0 - 50 51 - 100 101 - 150 151 - 200 201 - 250 251 - 300 301 - 350 351 - 400 401 - 450 451 - 500 501 - 550 551 - 600 601 - 650 651 - 700 701 - 750 751 - 800 801 - 850 851 - 900 901 - 950 951 - 1000 1001 - 1500 more than/more than 1500 Territorial limits:   Max. weight at takeoff (Kg):   Serial number:   Extra:

Hull insurance

Insurable value:   CHF Exemption:   CHF Date when you want coverage to begin:

Liability insurance (third party insurance)

Liability for damages caused on the ground:   CHF Liability for injuries to passengers, including damages to the belongings accompanying them, up to a value of CHF 5,000.- for every passenger:   CHF Liability for injuries to passengers incl. CHF 5,000.-for every passenger. Liability insurance against injury to persons and damage to things suffered by third parties outside the aircraft as well as against injury to persons suffered by the passengers, including damage to the belongings accompanying the latter, up to CHF 5,000.- per passenger (standardised insurance coverage):   CHF Manager of the aircraft:   Date when you want coverage to begin:

Personal accident insurance - injury to persons

Passengers Pilots Crew Death:   CHF CHF CHF Permanent disablement (prog. 225%):   CHF CHF CHF Medical expenses (5 years):   CHF CHF CHF Search and rescue expenses:   CHF CHF CHF Date when you want coverage to begin:

Pilots

Names of the pilots Total hours of flying time Hours of flying time on the type of aircraft to be insured Licences

Additional information, accidents