Gliders-Form
Facebook
Twitter
Instagram
Linkedin
i capital group companies:
Lionel Isaacs
DJA Aviation
Associated Insurance Brokers
i capital advisers
0
Shopping Cart
Home
About
Meet The Team
Products
Third Party Liability
Air Rescue DJA
Pilot Excess
Contact Us
Menu
Gliders-Form
R
0.00
Third Party Legal Liability Proposal Form
(for Aeroclub members only)
Type Of Proposal
*
New
Renewal
Membership number
*
Inception date
*
Aircraft
*
Registration No
*
Inception
*
1 January 2019 – 31 December 2019
1 April 2019 – 31 December 2019
1 July 2019 – 31 December 2019
1 January 2019 – 31 December 2019
Sum Insured - 500,000 +R830.00
Sum Insured - 1,000,000 +R1,005.00
1 April 2019 – 31 December 2019
Sum Insured - 500,000 +R615.00
Sum Insured - 1,000,000 +R775.00
1 July 2019 – 31 December 2019
Sum Insured - 500,000 +R435.00
Sum Insured - 1,000,000 +R545.00
These premiums include a R 70 policy fee.
Note : Cover will only be in place once receipt of proposal form and premium have been confirmed by our office.
Administration fee agreement between DJA Aviation Pty Ltd and Client
The Client agrees that DJA Aviation can levy an administration fee of R70 per annum, which administration fee will be added to the premium. This administration fee includes the following services, which are additional to the intermediary services for which DJA Aviation receives remuneration in the form of commission from your insurer:
policy holder risk profiling and insurance needs analysis, including providing risk management advice;
managing and advising you on level of self-insurance and risk financing options;
handling premium payments and queries,
general advice outside of product specific advice;
assisting you with the formulation of claims;
negotiating claims with insurers;
facilitating of non-insurance value-add products;
managing uninsured losses; and
managing aggregate deductibles.
You as the Client may cancel this fee at any stage should you feel that you do not require these services. You acknowledge the nature of the services above, for which the administration fee is being charged.
DECLARATION
I/We declare that the aforementioned Aircraft is/are my/our property, and particulars are true and that no information has been withheld that might influence acceptance of the Insurance and I/we agree that this Proposal, signed by or caused to be signed by me/us shall form the basis of and form part of the contract between me/us and Insurers and to accept a policy subject to the terms, conditions and exceptions described therein.
Signature
*
Date
*
Comments
This field is for validation purposes and should be left unchanged.
Subtotal
Options
Total
Quantity
Add to basket
Category:
E-Forms
Related products
Gyroplane Form
R
0.00
Balloons
R
0.00
Microlight Form
R
0.00
Scroll to top