Hangar Keepers Form

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Name of InsuredName of Insured

Address of InsuredAddress of Insured

Telephone NumberTelephone Number

Does the Insured ever have aircraft that are not owned, or operated by them, in their care, custody or control at their premises?

YesNo

If yes, please provide the following details.

a) Average value any one aircrafta) Average value any one aircraft

b) Average total value at any timeb) Average total value at any time

c) Maximum value any one aircraftc) Maximum value any one aircraft

d) Maximum value at any timed) Maximum value at any time

e) Maximum value in any one hangare) Maximum value in any one hangar

f) Maximum value outside hangarsf) Maximum value outside hangars

g) Average number of aircraft in your care, custody or controlg) Average number of aircraft in your care, custody or control

h) Please provide details of any rotor wing aircraft included in aboveh) Please provide details of any rotor wing aircraft included in above

I) Average number of engines in the Insured’s care, custody or controlI) Average number of engines in the Insured’s care, custody or control

Does the insured require inflight hangarkeeprs cover, if so please provide pilot details and flying experience8. Does the Insured require in-flight hangarkeepers coverage? If so please provide details of Pilots full flying experience.

Anticipated revenue from this source of business9. Anticipated revenue from this source of business

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Hangar Keepers Form

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