Aviation Questionnaire
JEAN KRISTOFER ASENCE
Name of Proposed Life Insured or Owner: ________________________________________________________________
Please answer each question and provide details where appropriate.
1. STUDENT PILOT LICENSE
What type of aviation license do you hold? _________________________________________________________
2. If you are a commercial airline pilot or crew member, please give the name of your employer.
n/a
_____________________________________________________________________________________________
3. If you fly a privately-owned or chartered aircraft/helicopter, please indicate the number of flying hours as of the
date of this Questionnaire:
a. Private or club flying for pleasure ______________________________________________________________
b. Private flying for business ____________________________________________________________________
c. Private flying for other purposes, please specify (e.g. agricultural) School Requirement, 40 hrs training
___________________________________
4. What type(s) of aircraft do you presently fly and are you likely to fly in the future?
_____________________________________________________________________________________________
AIRBUS, CESNA, TECNAM
_____________________________________________________________________________________________
5. Are you involved or likely to be involved in any of the following types of flying:
a. Experimental or test flying (indicate whether for routine airworthiness or prototype testing)?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
b. Competitions, record attempts, acrobatics, stunts or exhibitions?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
c. Instruction (indicate whether club or commercial, beginner or advanced)?
_____________________________________________________________________________________________
BEGINNER
_____________________________________________________________________________________________
6. If you are engaged, or are likely to be engaged, in flying as a member of the armed forces, please state:
a. The branch of the armed forces you are serving in;
N/A
_____________________________________________________________________________________________
_____________________________________________________________________________________________
b. Your rank and the capacity in which you fly or expect to fly (e.g. pilot or other aircrew);
_____________________________________________________________________________________________
N/A
_____________________________________________________________________________________________
c. The nature and duration (e.g. number of hours per annum) of your flying or expected flying.
_____________________________________________________________________________________________
N/A
_____________________________________________________________________________________________
I declare that the answers I have given are, to the best of my knowledge, true, correct and complete and that I have
not withheld any material fact that may influence the assessment or acceptance of my application for insurance.
I agree that this form will be part of my application for insurance and that failure on my part to disclose any material
fact known to me may cause the policy, when issued, to be rescinded.
JEAN KRSTOFER ASENCE
Signature over Printed Name Signature over Printed Name of Owner Date
of the Proposed Life Insured
NOTE: The answers given by the Proposed Life Insured or Owner in this Questionnaire will not guarantee the approval in any way of the insurance
application. The Company reserves the right to further evaluate the application and/or ask for additional information as it may deem necessary.
BDO Life Assurance Company, Inc.
(Formerly Generali Pilipinas Life Assurance Company, Inc.)
BDO Corporate Center, 7899 Makati Avenue, Makati City, Metro Manila, Philippines
Customer Care Hotline: (632) 8854110 | Trunk lines: (632) 8854100, 8854200 | Fax (632) 3250792
NBU 2009012
