Pilots Income Protection Plan

Insure First W.L.L  Qatar General Insurance
  1. Complete the following form and then click the print button.
  2. Sign the printed form, scan and send it to info@insurefirst.com.qa, with a copy of your QID card and your spouse's if applicable.
Lump Sum Benefit: $
Lump Sum Benefit: $
Less than 55 55 to 59 inc. 60 to 64 inc.

Monthly benefit available is subject to a maximum of 85% of your net flying income.


Personal Statement

If you answered "Yes" to any other question(s) please provide full details in the section labelled "Other Details" including dates, doctors attended, time off work, treatment, etc. below. Continue on a separate sheet if necessary.


Declaration:

I, the proposed Applicant for the Insure First Insurance Brokerage ‘Pilots Income Protection Plan’ described above do hereby declare that all statements made in the Personal Statement concerning myself are complete and true and that they are correctly and fully recorded and that no material information has been withheld or omitted concerning my past and present state of health and habits of life.

I agree that any Medical Practitioner who has been, or may hereafter be consulted by me is authorised and directed by me to divulge to the Insurer any information he/she may have with regard to myself.

IMPORTANT

If there is any change in the information declared after the date you sign this declaration form and before any cover offered by us commences you must advise Insure First Insurance Brokerage immediately. We may alter the terms quoted to you in such circumstances.

If you do not make a true and complete disclosure of material information, we may at our election cancel your policy or modify the terms on which it was issued. It will also prejudice your ability to claim under the policy and we will not refund any premiums paid.


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You are applying for the Insure First Insurance Brokerage ‘Pilots Income Protection Plan’ and details of this Plan have been made available to you.