NAME OF THE INSURED

ADDRESS, PHONE AND FAX

TYPE OF AIRCRAFT

REGISTRATION MARK

COFA No.

PLACE & YEAR OF MANUFACTURE

VALUE OF AIRCARFT

No. OF ENGINES

PASSENGER AND CREW CAPACITY

PREVIOUS OWNER / OPERATOR

EXACT USE AND ESTIMATE OF ANNUAL HOURS

BASE OF THE AIRCARFT

GEORAPHICAL LIMITS AND MAIN ROUTES

THE AIRCRAFT HAS PURCHASED OR LEASED

LOSS HISTORY IN LAST FIVE YEARS

PILOT NAMES (IF IT IS POSSIBLE)

PILOT EXPERIENCE IN TOTAL AND IN THIS TYPE OF AIRCARFT

WHICH COVERAGE ARE REQUIRED

THIRD PARTY LIMIT

BAGGAGE / CARGO LIMIT

PASSENGER ACCIDENT /LIABILITY LIMIT

CREW ACCIDENT / LIABILITY LIMIT

THE AVERAGE PASSENGERS LOADING

EFFECTIVE DATE OF INSURANCE