Questionnaire

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General Aviation business
Galaxy Flying Academy Ltd.
Exact name of insured
(including any subsidiary/affiliated companies who
may operate the aircraft)

House# 44, Level-12, Road# 1,

Address of the insured Sector# 3, Jashimuddin Avenue
Uttara Model Town
Dhaka-1230, Bangladesh

Registration Agreed value Pass/crew seats

Make/model
Complete schedule of aircraft
Cessna C152 S2-AFB $35,000 2
Year1982
Cessna C152 S2-AFS $35,000 2
Year1983
Cessna C172R S2-AFH $75,000 2+1
Year1998
Cessna C172R S2-AFJ $55,000 2+1
Year1999

Limits required for third parties and passengers

Combined single
limit (th ird parties OR Third party With passenger legal
liability limited to:

J
and passengers): legal liability:

I $100.000 1 $30,000 1 $10.000

Any one accident

Pilot details
Age Licences Ratings - total hours
Name (including hours on make and
model and tvoe)
CPL(616), FIR, IR · C152: 1450:00 Hrs+
Capt Moshiur Rahman 36
C172: 1000:00 Hrs+
PA28: 50:00 Hrs+
Total: 2500:00 Hrs+
CPL(513), FIR, IR C152: 1670:00 Hrs+
Capt Md Rajib Uddin 36 C150: 100:00 Hrs+
Total: 1770:00Hrs+
CPL, FIR, IR C152: 663:00 Hrs+
Capt Asfia Faruque Fedia 34
C152: 210:00 Hrs+
Hasan Al Zubayer Rony 31 CPL, FIR, IR
Note: We regularly recruit part time instructors, Check Pilots from Civil Aviation Authority also fly as_ p~rt
of taking Standardization Checks for Instructors, Students, Monitoring Flights carried out by Civil Aviation
Authority Fliqht Ooeration lnsoectors (FOi) , Deputv Flioht Ooerations lnsoectors (DFOI)
 .~ '= I - · ' t- I -': .. I ·.::

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Exact uses of aircraft and estimated utilisation for each different use
Use Percentage of time
C152 S2-AFB 471 :15 39%
C152 S2-AFS 329:35 28%
C172 S2-AFH 335:05 29%
C172 S2-AFJ 069:00 4%

Number of hours utilisation for the last 12 months and estimated utilisation for the forthcoming 12 months

Last 12 months: 1 1205:00 I Hours per aircraft: AVG

300:00hrs

Next 12 months:
I 2200:00 I Hours per aircraft: AVG
550:00 Hrs

Details of all losses for the last five years and any events which may be potential losses for both aircraft and
pilots
Yes, $40,000 Hull Value of Aircraft Claim due to incident, No third party, crew, or passenger losses
claimed.

Geographical areas of operation/flight routes (with frequencies) including if applicable details of any flights to
USA
NIA

Geographical location where the insured's operation/aircraft is based

Shah Makhdum Airport (VGRJ), Rajshah i, Bangladesh

Details of company/ies providing maintenance to the aircraft

IOwn Aircraft Maintenance

Will aircraft be hangared/tied down/open?

We have our own hangar based in Shah Makhdum Airport, Rajshahi, Bangladesh

Any additional information which may be of Interest to Insurers

We have two Cessna 172S aircraft in process of procuring.

If existing insurance In place, confirmation

of current rates and insurers Involved Date coverage will Incept:
Sena Kallyan Insurance
_31-Dec-2022
What is your annual turnover?
[$450.000
•
Alternatively, please Indicate
I one of the following:
Is your annual turnover in /No*
excess of GBP1 million?
Is your annual turnover in No*
excess of GBP8.6 million

What Is your balance sheet total (difference between assets and liabilities)?
Alternatively is your balance sheet No*
_ . total greater than GBP4.5 million?
[ I

Average number of employees?

[ 40 empk>yee I
Operations inside the European economic area?
No. Operation will only be limited to Bangladesh Airspace.
(•delete as appl icable)

This proposal will fonn the basis for obtaining tenns from insurers. The answer to some sections may involve further details being requested.

We would remind you that it is necessary for every insured to disclose to insurers immediately any infonnation, including changes in
circumstances, which might affect the judgement of the insurers in assessing the risk or the premium, and failure to disclose such infonnation or
changes could void the insurance contract.
Signing this proposal fonn does not bind you to complete the insurance, but it is understood and agreed that this proposal shall fonn the basis of
the contract should a policy be issued.
I have read the above. I hereby declare that to the best ofmy 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 insurers in regard to this proposal.

Signed

Position in company I Chief Flight Instructor ]

Date I 07-Dec-2022 ]