third party liability insurance parachutes/hang gliders ... · pdf filethird party liability...
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AXA Versicherung AG Versicherungsagentur für Flugsport 6345 Kössen, Austria, Dorf 2, Telefon: +43-(0)5375-5314, Fax: 2160 Contact: Hedi Plangger, +43-(0)676-5112825, email: [email protected]
Third Party Liability Insurance Parachutes/Hang Gliders/Paragliders
(non-motorised, inclusive emergency rescue costs) Application according current General and special AXA-insurance Regulations
Insurance sums: Third Party Liability insurance for parachutes, non-motorised hang gliders and paragliders, valid worldwide (except USA), competition risks included
€ 1.500.000,--
(at least) SDR 750.000,-- loss liability (without prior damage to property) € 12.000,-- Emergency rescue costs resulting from accidents with the glider insured (personal rescue only) (please choose your option below)
€ 2.600,-- or € 10.000,--
! Option with € 2.600,-- insurance sum for emergency rescue costs Annual Premium (inclusive insurance tax) € 70,-- Annual Premium for members of a NAC (inclusive insurance tax) € 60,--
! Option with € 10.000,-- insurance sum for emergency rescue costs Annual Premium (inclusive insurance tax) € 90,-- Annual Premium for members of a NAC (inclusive insurance tax) € 80,-- Policy Holder Title, first name
surname
Address
post code, city, country
nationality
date of birth e-Mail-address
telephone - office telephone private fax
profession
! I am member of following NAC:
membership number:
Insured Glider (only solo gliders, no tandem) ! Paraglider ! Hang Glider ! Parachute Three gliders for personal use only may be on one policy. Only one glider at the time may be used. Type year of manufacture Serial number
Start of Cover: day/month/year
/ / insurance period:
1 year Payment of premium: yearly by bank transfer
V 04/2014
Place / Date
Signature