Authorised and Regulated by the Financial Conduct Authority s1

Authorised and Regulated by the Financial Conduct Authority s1

<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>

View Full Text

Details

  • File Type
    pdf
  • Upload Time
    -
  • Content Languages
    English
  • Upload User
    Anonymous/Not logged-in
  • File Pages
    2 Page
  • File Size
    -

Download

Channel Download Status
Express Download Enable

Copyright

We respect the copyrights and intellectual property rights of all users. All uploaded documents are either original works of the uploader or authorized works of the rightful owners.

  • Not to be reproduced or distributed without explicit permission.
  • Not used for commercial purposes outside of approved use cases.
  • Not used to infringe on the rights of the original creators.
  • If you believe any content infringes your copyright, please contact us immediately.

Support

For help with questions, suggestions, or problems, please contact us