Pilot Lisans Kaybı Sigorta Formu

    Enrolment Form – TALPA Loss of Licence Scheme

    Important advice to all applicants

    All sections of the enrolment form must be fully completed. You should be aware that this insurance is subject to a comprehensive previous medical condition/disability exclusion in relation to all medical/health matters. The full definition of ‘previous medical condition/ disability’ is:

    Any condition for which you have sought advice, diagnosis, treatment or counseling or of which you were or should reasonably have been aware of or for which you had been treated at any time in the 36 months prior to the inception of this voluntary insurance.’

    CaptainFirst Officer


    I hereby declare that to the best of my knowledge and belief the answers given to the questions contained in the enrolment form are true and complete.

    I agree to the terms and conditions of this plan, including the previous disability exclusion above.

    This declaration forms part of the TALPA Loss of License Policy and any false declaration made hereunder may invalidate
    your cover.