|
|
|
|
CARIBEX
INSURANCE
Caribex has been associated with the London and US insurance markets for over 20 years. In this area we have worked as risk managers and new business developers. The areas we have hands on experience in include:
Caribex Inc. does not act as a broker or hold out as a licensed insurance sales company. We will place your request without brokerage fees directly into the London markets thus saving you ,where permissible, 100% of the local brokerage fees. If you have a need for new coverage or wish for a mid- term confidential market indication or formal quote on existing policies, please contact us with the particulars.
Caribex Inc. Ph 561 852 3989 Fax 561 862 2767
For direct quotes please copy the following form into a MS Word doc, and email as a attachment
PRE- APPLICATION FOR INSURANCE COVERAGE Date _______________
Name of insured (s)____________________________________________________________________
Address of Insured_____________________________________________________________________
Ph_______________Fax_______________Cell phone___________ Email________________________
Type of Aircraft_____________________ Reg Number_______________________ Manufactures Serial
number_______________________ Engines SN’s L ____________R________________ Are engines
insured separately __________________________Props SN’s L ____________ R__________________
Year of Manu.__________ TT ______________ TC __________________ Date of coverage or be
Effective:___________________ Present location of aircraft:___________________________________
Hull to be covered at $_______________________ Liability at $_______________________________
Areas of expected operations:____________________________________________ Aircraft to be based
at:________ Expected utilization monthly: _____________Please Scan/Fax copies of Registration, Bill of Sale, Airworthiness Certificate. Has aircraft been placed into a pre-purchase facility?______________________
Additional Insured: Name of mortgage holder, Lessor, lender, secured parties:___________________ ____________________________ Address________________________________________________
Contact information Ph, ____________Fax, ________Address________________________________ ______________________________________________________
Pilot data Name of Pilot (s) Capt____________________ F.O. _____________________________
experience level of Pilots TT, Time in this aircraft Capt: _________F.O. ___________Total IFR hours
Capt: ________ FO_____ License level of Pilots Capt: ___________ FO ___________ Dates of last
Simulator based training: Capt._______FO __________ Name of facility_________________________
Please fax copies of licenses, physical & training documents
Duty of Disclosure: History of Insured: Has the Insured had any claims for the last 10 years?___________ If yes, please explain on a separate attached document Has the aircraft any damage history?____________ If yes, please attach particulars on a separate document.
SIGNED____________________________ Print name_______________________
Duty of Disclosure - It is a legal requirement world-wide that anyone seeking a new policy of insurance/reinsurance or cover for additional risks or renewal under an existing policy, must disclose any information that might influence the insurers in fixing the premium or determining whether to accept the risk. Under law failure to do so may entitle insurers to avoid coverage from inception and seek repayment of any paid claims. If you are in any doubt as to whether information is material you should disclose it.
|
|
|