SKYDIVING THIRD PARTY INSURANCE

Name (one name)

Please provide your data for the insurance purpose. It will be exactly the same on your policy, as you write it here, so make sure not to make mistakes. I will not be neither correcting nor checking up the information you provide. Correcting mistakes delays the issuing of the insurance.

Last name (one last name)

Your nationality is:

🇷🇺Russian, 🇺🇦Ukrainian, 🇧🇾Belarusian
None of the above

You declare that the person listed does not hold citizenship of any of the following countries: Russia, Belarus, or Ukraine. If this information is withheld, the insurance contract is void. ❗ Unfortunately, we are currently unable to insure citizens of Russia, Ukraine, or Belarus. Please leave your email address so we can contact you if the situation changes.

❗ Unfortunately, we are currently unable to insure citizens of Russia, Ukraine, or Belarus. Please leave your email address so we can contact you if the situation changes.

Notification email

YOUR ID DOCUMENT NUMBER (for Polish citizens, obligatory PESEL)

⚠️ ATTENTION / ATENCIÓN:
This ID number will be used on the insurance policy.
Este número se usará en la póliza de seguro.

Please enter your real document number exactly as on your official ID.
Por favor, introduce tu número real de documento exactamente como aparece en tu documento oficial.

Without a correct ID number, we cannot issue the insurance.
Sin un número de documento correcto, no podemos emitir el seguro.

Wrong or fake numbers (e.g. 00000000000) will be rejected.
Los números incorrectos o falsos (por ejemplo 00000000000) serán rechazados.

👉 The field requires 11 characters: if shorter, zeros will be added at the beginning; if longer, extra characters will be deleted.
👉 El campo requiere 11 caracteres: si es más corto, se añadirán ceros al principio; si es más largo, se eliminarán los caracteres sobrantes.

Your ID Document is:

passport
id_card
pesel

Postal code

City

Country

Street

House nº

Flat nº

Email:

Email

Confirm Email

Preferred starting date

Today
Next Month

No worries, the price is the same.

🇬🇧 Click this button to accept all required consents with a single click:
🇪🇸 Haz clic en este botón para aceptar todos los consentimientos requeridos de una sola vez:

✅ Accept All

You need to accept all the boxes:

I have read the description of the insurance scope and I accepted rules of Regulations of the Aviation Enthusiasts Club (KSML).
I declare that I consent to the processing of personal data provided by me for the purpose of organizing insurance contracts by the entities: Finansowa Chata Piotr Słowik and Sopockie Towarzystwo Ubezpieczeń ERGO Hestia SA. The specified data may be used for the purposes related to the conclusion and performance of insurance contracts, as well as reminding about expiring protection (including sending email and SMS messages) and, in this scope, may be transferred to other entities and processed by these entities, in particular insurance companies, while observing all precautions required by the Act of August 29, 1997, on the Protection of Personal Data. At the same time, I declare that I have been informed that, in accordance with Art. 24(1)(3) and (4) of the Personal Data Protection Act, providing data is voluntary, and everyone has the right to access the content of their personal data and to correct them.
I understand that the insurance takes effect immediately and is non-cancellable and non-refundable.
I declare that I have familiarized myself with the information regarding the group insurance policy concluded with STU Ergo Hestia S.A. based in Sopot 81-731, ul. Hestii 1, concerning the terms of insurance coverage and exclusions from its scope, principles regarding the financing of insurance coverage by the Club of Aviation Sports Enthusiasts, and possible reasons for the refusal of benefit payment.
I declare that before expressing my consent to provide insurance coverage/finance the insurance premium cost, I received and accepted the General Insurance Conditions. I declare that I have been informed that the Insurer does not receive remuneration or other benefits in connection with offering the possibility of using insurance coverage or activities related to the performance of the insurance contract.
I declare that before entering into the insurance contract, the General Insurance Conditions have been provided to me in a durable medium, considered to be a PDF file, CD, or printed format.

Signature

Clear Signature

SKYDIVING THIRD PARTY INSURANCE

INSURANCE TYPE

VALIDITY

RANGE

SCOPE

LANGUAGE

PRICE

How to buy

1️⃣ Fill the form

2️⃣ Make the payment

3️⃣ Send payment confirmation

⏳ Be kind with time

4️⃣ The Insurance pdf document: