<p>Hang Gliding</p><p>Contact name: </p><p>IFA company name: </p><p>Telephone number:</p><p>Email: GENERAL INFORMATION</p><p>Full name of life proposed Sum Assured Preferred Monthly Premium</p><p>Title (Mr, Mrs, Miss, other) Period of Policy</p><p>Date of Birth Level/Decreasing Term Assurance</p><p>Height Weight Have you smoked in the last 12 months? </p><p>INFORMATION ABOUT YOUR HANG GLIDING</p><p>Rating Date obtained None ٱ Please indicate the type of hang-gliding proficiency rating that you have. ______Elementary pilot ٱ ______Club Pilot ٱ ______Pilot / Cross country ٱ ______Advanced pilot ٱ ______:Other ٱ ______</p><p>Are you an instructor? Yes / No</p><p>Are you a member of a sanctioned hang-gliding club or national Yes / No organization? If yes, please provide details. </p><p>How long have you been hang-gliding? Years Months</p><p>Please provide the following hang-gliding details for the last 12 Number of flights: months. Number of hours:</p><p>Please provide the following hang-gliding details, estimated for the Number of flights: next 12 months: Estimated hours:</p><p>Please describe the nature of the terrain over which you usually fly, e.g. coastal, lakes, mountainous, open country etc.</p><p>In the past 3 years, have you:- Yes / No participated in any hang-gliding competitions? participated in endurance events, cross country, aerobics or air slalom etc? If Yes, please provide details.</p><p>Pulse Insurance Limited Authorised and Regulated by the Financial Conduct Authority 6 Oxford Court, St James Road, Brackley, Northants, NN13 7XY Tel: 01280 841430 Fax: 01280 702977 E-mail: admin@pulse-insurance.co .uk Website: www.pulse-insurance.co.uk For the next 12 months, do you intend to Yes / No participate in any hang-gliding competitions? participate in endurance events, cross country, aerobics or air slalom etc? If Yes, please provide details.</p><p>In the past 3 years, have you ever used a powered, experimental, Yes / No prototype or home built glider? If yes, please provide details.</p><p>Do you intend to use a powered, experimental, prototype or home Yes / No built glider in the next 3 years? If yes, please provide details.</p><p>Do you intend to take part in hang-gliding record attempts in the Yes / No next 3 years? If Yes, please provide details.</p><p>Have you ever had an accident or sustained an injury as a result of Yes / No your hang-gliding activities? If Yes, please provide details.</p><p>Signed (client or IFA): Date:</p><p>Pulse Insurance Limited Authorised and Regulated by the Financial Conduct Authority 6 Oxford Court, St James Road, Brackley, Northants, NN13 7XY Tel: 01280 841430 Fax: 01280 702977 E-mail: admin@pulse-insurance.co .uk Website: www.pulse-insurance.co.uk</p>
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