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

APPLICATION FORM - NON 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

Lead Premium(excl. TPLL War Premium)

Lead TPLL War Premium

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

DESCRIPTION OF ACTIVITIES

EXPOSURE CRITERIA

                        (estimated figures for insured period)

Number of Departures

   (to be completed iro airports only)

Number of Passengers

Non-USA/CANADA Turnover

USA/CANADA Turnover

Number of Employees

Number of Motor Vehicles at airside

IMPORTANT:

Any kind of Security or Screening activities?

yes                                     no

If " yes " please describe below

REMARKS