By Ian Wilson from London, England (Gliding at Dunstable) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

Gyroplane Form

Name: Gyroplane Form
SKU: 6289
Availability: InStock

R0.00

Third Party Legal Liability Proposal Form (for Aeroclub members only)

Type Of Proposal *

Membership number *

Inception date *

Aircraft *

Registration No *

Inception *

1 January 2025 – 31 December 2025

1 April 2025 – 31 December 2025

1 July 2025 – 31 December 2025

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.
*Kindly send a copy of your latest Aeroclub membership certificate and proof of payment to Natashas@dja-aviation.co.za in order for cover to be processed*
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*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

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