Your written responses and this document and any attachments forms part of an application for aviation insurance or forms part of Underwriters file for an existing insurance policy or changes to an existing insurance policy. You must answer each question completely and accurately. Failure to do so may result in delay of policy issuance or coverage, a denial or reduction of benefits or cancellation or voiding of coverage.Submission of this electronic or digital document along with your digital signature shall have the same legal force and effect as if you had signed the document with your handwritten original signature.
PRIOR OR PENDING LOSSES, CLAIMS, INCIDENT and OTHER HISTORYREAD CAREFULLY AND ANSWER COMPLETELY
I HEREBY AFFIRM ALL OF THE INFORMATION HEREIN IS TRUE AND CORRECT AND ALL STATEMENTS MADE IN THIS DOCUMENT HAVE BEEN ANSWERED TO THE BEST OF MY ABILITY AND ARE TRUE AND COMPLETE.I HAVE NOT KNOWINGLY OR INTENTIONALLY CONCEALED OR MISREPRESENTED ANY FACT. I HAVE READ AND I UNDERSTAND THE DISCLOSURE STATEMENT ON THIS DOCUMENT. THIS FORM WILL BECOME PART OF THE INSURANCE APPLICATION/PROPOSAL. ALL FRAUD STATEMENTS ARE APPLICABLE.AIRCRAFT OPERATORS VOLUNTARILY AGREE TO UNDERGO AND PROVIDE AN APPROVED DRUG OR ALCOHOL SCREEN TEST WITHIN 48 HOURS IN THE EVENT OF A CLAIM OR AN EVENT OR INCIDENT THAT MAY LEAD TO A CLAIM.
DISCLOSUREYour written responses and this document and any attachments forms part of an application for aviation insurance or forms part of Underwriters file for an existing insurance policy or changes to an existing insurance policy. You must answer each question completely and accurately. Failure to do so may result in delay of policy issuance or coverage, a denial or reduction of benefits or cancellation or voiding of coverage.Submission of this electronic or digital document with your typed digital or electronic signature shall have the same legal force and effect as if you had signed the document with your handwritten original signature.
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