QUESTIONNAIRE AVIATION CIVILE ET MILITAIRE

!
"
#
$ %
$ %
' (
*
-
.
0
.
&
&
/
!
1
#
3
4
' (
)
&+&
+,"
+,"
+,"
&+&
&+&
&+&
2
!
%
(
!
!
(
2
5
+,"
"
(
&
&+&
&+&
&+&
&+&
&+&
%
5
6
+,"
+,"
+,"
+,"
+,"
!
5
7
7(
5
7
7
7
7
2
8
9
(
2
:
4
%
%
;
%
<
!
/
# +," !
+,"
&+&
+,"
+,"
&+&
&+&
+,"
&+&
+,"
&+&
+,"
&+&
+,"
&+&
(
2
*
!
/%
/
7
7
7
%
# + 7
.
# +,"7
-
.
0
.
/
!
*
# +,"7
Je, soussigné(e)
..........................................................,
déclare que les réponses ci-dessus font partie intégrante de
la proposition d'assurance.
#
$ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%&
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%