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LAMPS APPLICATIONS OR PROPOSAL FORMS (SUBSECTION 21) AON LIMITED, AVIATION
LAMPS AIRSIDE LIABILITY PROPOSAL FORM

1.
Name of Insured


2.
Address of Insured


3. Full details of the business/work being
undertaken:



4.
Details of airport location and where Insured
intends carrying out operations in relationship to
airport:



5.
Number and type of vehicles used at each
location:



6.
Frequency of visits to airport:



7.
Period of cover required



8.
Give details of distance of operation/ vehicles
from aircraft:



9.
Advise turnover/receipts resulting from aviation
activities:



10.
Loss record full details, if any, including amounts:



11.
Advise details of limits required (if known):











AON LIMITED, AVIATION
Duty to Disclose Material Information

Material Information is information that would influence an insurer in deciding whether a risk is
acceptable and, if so, the premium, terms and conditions to be applied. Failure to disclose such
information could result in the policy being rendered void so that claims would not be paid.

The duty of disclosure is re-imposed when there are changes or variations in cover and when the
policy is renewed or extended. In addition, changes which substantially increase the risk, or relate to
compliance with a warranty or condition in the policy must be notified at once.

To ensure that cover is not prejudiced, please refer to Aon if there is any doubt as to what
information needs to be disclosed.


Declaration

I hereby declare that to the best of my knowledge and belief, the particulars and answers herein are
true and correct and that I have not knowingly withheld any information which would influence the
decision of the underwriters in regard to this proposal.

It is understood and agreed that this proposal shall form the basis of the contract should a policy be
issued.


Name:


Signature:

Date:



Financial Services Authority [FSA] Regulation of Insurance Intermediaries

The FSA is responsible for regulating insurance intermediaries in the United Kingdom from January
2005. The FSAs remit is to ensure consumers interests are protected, insurance intermediaries are
properly managed and the employees of regulated firms are competent and properly trained. Aon
Limited is a regulated intermediary.
AON LIMITED, AVIATION
In order that Aon conducts its relationship with you in the manner required by the FSA and at the
same time provides you the protection they require, we kindly request that you supply us with the
following information from your most recent annual report and accounts. We will be requesting this
information from you annually.

Client Name:


(the policyholder that executes the contract of insurance)

1. Annual
Turnover

What is your annual turnover?



Alternatively delete as appropriate:

Is your annual turnover in excess of GBP1 million?
Yes/No

Is your annual turnover in excess of GBP8.5 million?
Yes/No

2. Balance
Sheet
Total

What is your balance sheet total?


(total of all assets without any deduction for liabilities i.e. fixed assets and current assets)

Alternatively delete as appropriate:

Is your balance sheet total greater than GBP4.1 million?
Yes/No

3.
Average number of employees

Is your average number of employees during the

coming year greater than 250?
Yes/No (please delete as applicable)

4.
Operations inside the European Economic Area (EEA)

Do you have business operations located in at least one

of the following countries? Yes/No (please delete as applicable)

The
EEA:
Austria, Belgium, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany,
Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg,
Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, United
Kingdom.

Please return this form to your Aon Account Handler as soon as possible