Loss of License Insurance - Fly Crew Center

Loss of licence insurance for pilots

GEORGE Loss of Licence Scheme - Enrolment Form

Important advice to all applicants
All sections of the enrolment form must be fully completed.
You should be aware that this insurance is subject to a comprehensive previous medical condition/disability exclusion in relation to all medical/health matters. The full definition of previous disability is:
Any condition for which you have sought advice, diagnosis, treatment or counseling or of which you were or should reasonably have been aware or for which you had been treated at any time in the 24 months prior to your attachment to this scheme

Information

*Title or rank

Male

Female

*Surname

*First name(s)

*Date of birth

*Permanent address

*Country

*Post Code

Tel no

*Requested inception date of insurance cover

*Annual total earnings from flying EUR

Other loss of licence insurance

*Are you entitled to any other loss of licence insurance arranged by you or employer?

Yes

Sum to be insured

*Sum to be insured EUR

Declaration

*I hereby declare that to the best of my knowledge and belief the answers given to the questions contained in the enrolment form are true and complete. I agree to the terms and conditions of this plan, including the previous disability exclusion above.

Loss of licence insurance for pilots

GEORGE Loss of Licence Scheme - Enrolment Form

Information

Other loss of licence insurance

Sum to be insured

Declaration

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