AVIATION WAR EXCESS THIRD PARTY LEGAL LIABILITY (RE)INSURANCE APPLICATION FORM

APPLICATION FORM - AIRCRAFT OPERATIONS

completed by:

Name

Cedant

Date

POLICYHOLDER

CEDANT (Broker/Company)

REINSURED (if any)

Name

Address Street

Address Town

Address Country

Contact Person

Phone Number

Fax Number

E-Mail Address

Reference

PERIOD

Inception Date

InceptionTime

00.00 h GMT

Expiry Date

31/05/2003

Expiry Time

12.00 h GMT

SUM INSURED A) XS USD 50 MIO

in respect of

Order hereon

SUM INSURED B) XS USD 50 MIO

in respect of

Order hereon

SUM INSURED C) XS USD 50 MIO

in respect of

Order hereon

SUM INSURED D) XS USD 50 MIO

in respect of

Order hereon

PRIMARY POLICY DETAILS

Leading Insurer

Other Insurers

Policy Number

Insured Limit

Insured TPLL War Limit

Policy Period

Geographical Limits

Please attach a copy of Primary Policy

IMPORTANT:

Any other additional TPLL War Policies in force ? (except above Primary Policy)

yes                                     no

EXPOSURE CRITERIA

                        (estimated figures for insured period)

Number of Passengers  ( as per IATA Definition)

Commercial

Freight only

Non-Commercial

Wide-body Aircraft

Number of Aircraft

Hybrid-body Aircraft

Number of Aircraft

Narrow-body Aircraft

Number of Aircraft

Other Jets

Number of Aircraft

Turboprops

Number of Aircraft

Propeller Aircraft

Number of Aircraft

Helicopters

Number of Aircraft

IMPORTANT:

Please attach fleet schedule (type, registration number and seating capacity of each aircraft)

REMARKS