AVIATION Q- 2.
Aviation Questionnaire
We thank you for applying for an HDFC Life Insurance Policy. To enable us to assess your
application, kindly send this Aviation Questionnaire answered by the Life to be Assured and duly signed by
the Life to be Assured and Proposed Policy Holder, if any.
Application No / Proposal No
Name of Life to be Assured
Section – I Regarding flying experience as a pilot
1. Do you fly in capacity of pilot? Yes / No
If yes, please answer following question.
If no, please proceed to answer question in Section-II.
2. When did you learn to fly?
3. Mention type of license held.
Total to date
4. Flying Hours
In the last 12 months
Rotary wing aircraft
5. Kindly tick on type of aircraft flown?
Fixed wing aircraft
6. Have you ever had any flying accident, been Yes / No
grounded, or had your licence suspended?
If yes, please provide details.
Section – II Regarding flying as commercial aircrew
7. Do you fly in capacity of commercial aircrew? Yes / No
If yes, please answer following question.
If no, please proceed to answer question in
Section – III.
8. Please give precise capacity. (e.g. navigator or
exact designation as aircrew personnel).
9. Routes served and the nature of flights
10. Kindly tick on type of aircraft flown. Rotary wing aircraft
Fixed wing aircraft
11. Kindly tick on weight of aircraft flown. Less than 2300kg
More than 2300kg
12. Are you involved in any low level flying or flights Yes / No
between unrecognized airfields?
If yes, please provide details of airfields.
Section – III Business, pleasure, civilian instructor flying, flying as a civilian test pilot or technical
observer.
13. Is purpose of flying for business, pleasure or
civilian instructor flying?
If yes, please answer following question.
If no, please proceed to answer question in
Section – IV.
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a) Civilian test pilot b) Civilian Instructor flying
14. Tick on exact purpose of flying.
c) Technical observer d) Business e) Pleasure
Yes / No
15. Are you involved in any kind of flying instruction?
Frequency of flying as flying
If yes, please provide details e frequency and
instructor………………….
number of hours p.a.
Number of hours as flying
instructor……….……………
16. Are you involved as civilian test pilot or technical
observer?
If yes, please mention exact flying activities (e.g.
routine testing for airworthiness experimental or
prototype aircraft).
17. Details of any flying in aircraft not holding current
Certificate of Airworthiness
18. Kindly mention geographical limits.
Section – IV Please give details of your expected number of flying hours per annum in the
following categories.
Hours p.a as pilot Hours p.a. as passenger/aircrew
Pleasure or recreation hrs p.a Pleasure or recreation hrs p.a
Business hrs p.a Business hrs p.a
Civilian Flying instructor hrs p.a Civilian Flying instructor hrs p.a
Commercial aircrew hrs p.a Commercial aircrew hrs p.a
Civilian test pilot or technical Civilian test pilot or technical
observer hrs p.a observer hrs p.a
Operator of aircraft/employer Operator of aircraft/employer
hrs p.a hrs p.a
Other flying
Please give details of any other flying activities you
may participate in now or in the future
An incomplete Questionnaire will not be considered valid
Declaration of Life to be Assured:
I agree and understand that the information given herein is true and complete in all respects and will form an
integral part of the proposal made by me for an insurance policy from HDFC Life Insurance Company
Limited and that failure to disclose any material fact known to me may invalidate the contract.
Signature/thumb impression
(Life to be Assured) Date:……………………
Place:…………………..
Signature/thumb impression
(Proposed Policy Holder if different Date:……………………
from Life to be Assured) Place:…………………..
In the case of thumb impression\ signature in vernacular language:
In case of thumb impression of the Life to be Assured the same should be attested by a person of standing whose
identity can be easily established, but unconnected with the Company and this declaration should be made by him.
I hereby declare that I have explained the contents of this form to the Life to be Assured in ________ language and have
truthfully recorded the answers provided to me and that the Life to be Assured has signed /affixed thumb impression(s)
above after fully understanding the contents thereof.
Date:……………………
Place:…………………..
Signature
Name and address of the declarant
HDFC Life Insurance Company Limited. CIN: L65110MH2000PLC128245. IRDAI Registration No. 101.
Regd. Off: 13th Floor, Lodha Excelus, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai - 400 011.
For queries or more information, call us on 1860-267-9999 (Local charges apply). DO NOT prefix any country code e.g. +91 or 00. Available Mon-Sat from 10 am to 7 pm |
Email - service@hdfclife.com | nriservice@hdfclife.com (For NRI customers only) | Visit - www.hdfclife.com
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