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    Civil Aviation Questionnaire

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    tatacrt
    This document is a civil aviation questionnaire for pilots, crew, or passengers not traveling as fare-paying passengers on commercial flights. It collects information about an applicant's flying experience including aircraft types flown, licenses held, hours of experience, nature of intended future flights, and participation in special activities like stunt flying or test piloting. The applicant declares that their answers are truthful and complete to the best of their knowledge.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Civil Aviation Questionnaire

    Uploaded by

    tatacrt
    167 views2 pages
    This document is a civil aviation questionnaire for pilots, crew, or passengers not traveling as fare-paying passengers on commercial flights. It collects information about an applicant's flying experience including aircraft types flown, licenses held, hours of experience, nature of intended future flights, and participation in special activities like stunt flying or test piloting. The applicant declares that their answers are truthful and complete to the best of their knowledge.

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    This document is a civil aviation questionnaire for pilots, crew, or passengers not traveling as fare-paying passengers on commercial flights. It collects information about an applicant's flying experience including aircraft types flown, licenses held, hours of experience, nature of intended future flights, and participation in special activities like stunt flying or test piloting. The applicant declares that their answers are truthful and complete to the best of their knowledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    167 views2 pages

    Civil Aviation Questionnaire

    Uploaded by

    tatacrt
    This document is a civil aviation questionnaire for pilots, crew, or passengers not traveling as fare-paying passengers on commercial flights. It collects information about an applicant's flying experience including aircraft types flown, licenses held, hours of experience, nature of intended future flights, and participation in special activities like stunt flying or test piloting. The applicant declares that their answers are truthful and complete to the best of their knowledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    TataAIA/NB/DM/66.

    Civil Aviation Questionnaire


    (For pilots, crew or passengers in respect of aviation other than as a fare-paying passenger on a
    scheduled flight on a recognized air route. Applies to flights by aero plane, helicopter
    balloon and airship).

    Name of Proposed Insured: ...................................................................................................................

    Policy No: ........................................................................................ Dated: ........................................

    1. Flying experience Yes No


    Have you ever flown as a pilot:?
    If Yes:-
    a) What type of licence do you hold? ...........................................................
    b) What types of aircraft are you authorised to fly? ...........................................................
    c) When did you learn to fly? .........................................................
    d) How many hours flying as a pilot
    i) have you done to date? ..........................................................
    ii) have you done in the last 12 months? ..........................................................
    e) Have you been involved in any flying accidents? Yes No
    If so, please give details.
    ..........................................................................................................................................
    f) Have you ever had your license revoked or been grounded? Yes No

    2. Nature of intended flying


    a) Type of aircraft (make, model name & number) .........................................................
    No. of hours as pilot .........................................................
    No. of hours as passenger .........................................................
    Purpose (eg pleasure, business, air taxi, as instructor) ...................................................... =

    b) Who owns the aircraft? Does the owner hold an Air Operators Certificate?
    .....................................................................................................................................

    c) Who maintains the aircraft? ...........................................................................................

    d) Where do you intend to fly (ie starting points and destinations)? ......................................

    e) Will flights be between licensed airfields? If not please give details. Yes No
    ..............................................................................................................................................

    Tata AIA Life Insurance Company Limited


    .(IRDA Regn. No. 110) CIN - U66010MH2000PLC128403
    Registered Office & Corporate office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai – 400013
    For more information, call our Helpline Numbers 1860-266- 9966 (local charges apply).
    Unique Reference Number L&C/Misc/2014/Nov/241
    TataAIA/NB/DM/66.1

    f) Do you intend to participate in air competitions of any kind, formula air racing, exhibitions,
    aerobatics or stunt flying? If so, please give details. Yes No
    .................................................................................................................................................

    g) Do you intend to undertake any low-level or specialised flying or manoeuvring, eg crop


    spraying, inspection? Yes No

    h) Do you intend to fly as a test pilot? If so, please state:- Yes No

    I) the name of your employer ...............................................................................................


    .
    II) whether the aircraft are prototypes, new, reconditioned, etc ...........................................

    I declare that the answers I have given are, to the best of my knowledge, true and I have not
    withheld any material information that may influence the assessment of acceptance of this
    proposal.
    I agree that this form will constitute part of my proposal for life assurance and that failure to
    disclose any material fact known to me may invalidate the contract.

    Signature of Proposed insured:______________________ Date:____________________

    Signature of Applicant:______________________ Date:____________________


    (If applicant is different from the proposed insured)

    VERNACULAR DECLARATION:
    In case the Proposed Insured/Applicant affixes a thumb impression or signs in vernacular.

    I__________________ holding ______________(ID card type) with number __________(ID


    card number) hereby declare that I have explained the contents of this declaration to the Proposed
    Insured/Applicant in ________________ language and that the Proposed Insured/Applicant has
    affixed his/her signature/thumb impression after fully understanding the contents thereof.

    ________________________________ _____________________
    Signature/Thumb Impression of Proposed Insured/Applicant Witness Signature

    Tata AIA Life Insurance Company Limited


    .(IRDA Regn. No. 110) CIN - U66010MH2000PLC128403
    Registered Office & Corporate office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai – 400013
    For more information, call our Helpline Numbers 1860-266- 9966 (local charges apply).
    Unique Reference Number L&C/Misc/2014/Nov/241

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