THIRD PARTY LIABILITY INSURANCE SCHEME
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THIRD PARTY LIABILITY INSURANCE SCHEME
R
0.00
RENEWAL PERIOD
:1 June 2019 to 31 May 2020 Inclusive
INSURERS
:Santam
AIRCRAFT DETAILS
Year Model
Make & Model of Aircraft
Passenger Capacity
Type of Engine
Registration Marks
Maximum take of weight
COVER: Third Party Liability only
These premiums include a R 65 policy fee.
R500,000 any one occurrence (Excluding Aerobatics at Air Shows)
*
Yes +R675.00
No
R1,000,000 any one occurrence (Excluding Aerobatics at Air Shows)
*
Yes +R975.00
No
R2,500,000 any one occurrence (Including Aerobatics at Air Shows)
*
Yes +R2,085.00
No
COVER: Third Party Liability only
Pro rata from March 2020 (Please note this section only applies if cover is taken out from 01 March 2020 – 31 May 2020)
These premiums include a R 65 policy fee.
Pro rata - R500,000 any one occurrence (Excluding Aerobatics at Air Shows)
Yes +R675.00
No
Pro rata - R1,000,000 any one occurrence (Excluding Aerobatics at Air Shows)
Yes +R295.00
No
Pro rata - R2,500,000 any one occurrence (Including Aerobatics at Air Shows)
Yes +R570.00
No
To renew your cover, please supply details of aircraft and cover required on the form below and return to DJA Aviation (Pty) Ltd
Please cover Third Party Liability under Aero Club Scheme
Cover will only commence on receipt of premium
Name:
Phone (B)
Fax:
Email
Address
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Aeroclub member number
Please supply details of any claims made against you in the past
CONDITIONS APPLICABLE:
All Pilots must be current members of the Aero Club and/or Affiliated Sections thereof.
The following aircraft are excluded from the Scheme:-
Microlights
Ordinary Gliders
Jet/Turbine Engine Aircraft
Aircraft exceeding 2,700kg
Uses include the following: Private, pleasure, rental to members of the Aero Club and/or Affiliated Section thereof for private, pleasure, training all forms of instruction, Aerobatics, competition Aerobatics and parachute dropping; airs how participation in the form of fly pasts, formation flying and aerobatics
WARRANTIES:
It is hereby warranted that ab-initio instruction shall only be carried out in respect of aircraft having 2 seats.
It is hereby warranted that Air Show Aerobatics are excluded in terms of the policy
unless the appropriate premium has been paid.
GEOGRAPHICAL LIMITS:
Republic of South Africa and bordering territories excluding Lesotho other than North and West of a line joining Libono, Roma, Mohaleshoek and Quthing. Overflying the whole of Lesotho in multi-engine aircraft permitted. -
PRIOR TO FLIGHT ACROSS BORDERS
- subject to the provision being made in the valid authority to fly, from the relative authorities to include flights across borders.
Administration fee agreement between DJA Aviation Pty Ltd and Client
The Client agrees that DJA Aviation can levy an administration fee of R65 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
*
Phone
This field is for validation purposes and should be left unchanged.
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