SkyGuard · Underwriting Counter Offer Complete on screen, then Print / Save as PDF. Unticked standard exclusions are hidden in print.
CONFIDENTIAL UNDERWRITING COUNTER OFFER
Life & Loss of Licence Products
Policy / Quote number
Life Assured
Identity / Passport no.
Product

UNDERWRITING ASSESSMENT — COUNTER OFFER

Issued by SkyGuard Insurance Ltd, a licensed composite insurer under the Anguilla Insurance Act (2022)

Purpose of this letter
Your application has been assessed and can be accepted on the revised terms set out in the attached Decision Schedule. Please read this documentation carefully — once signed and accepted, these terms form an integral part of your contract of insurance.
Action required
If you accept this counter offer, please complete the Counter Offer Declaration electronically, using the Accept Counter Offer facility on the final page (or sign in ink if you prefer). The accepted letter must be returned in full, failing which the policy cannot be issued. Cover commences once this counter offer has been accepted and the initial premium has been received.
Important notice
This offer is subject to the following:
Change in health, occupation or aviation activity
  • SkyGuard must be advised of any change in your health, occupation, aviation licence status, or flying activity between the date of your application and your acceptance of this counter offer. Any such change may require a reassessment of the risk; failure to disclose may render the policy voidable in accordance with the Anguilla Insurance Act (2022).
Commencement of cover
  • If your stipulated commencement date is not more than one month after the decision date above, cover is effective on receipt of the signed counter offer and initial premium, provided there has been no change in health, occupation or aviation activity.
  • If your stipulated commencement date is more than one month after the decision date, SkyGuard must be notified in writing of any material changes before cover starts, and cover will only commence from your stipulated commencement date.
Validity: this counter offer is valid for 30 (thirty) days from the decision date of , subject to section 29 of the Anguilla Insurance Act (2022), after which it lapses and the application must be re-underwritten.

Kind regards

SkyGuard Underwriting
Underwriter
Title
Email
Telephone
Confidentiality: this letter and any attachments are confidential and intended only for the addressee. If received in error, you may not disclose, copy or rely on the contents — please notify SkyGuard and destroy the letter.
SKYGUARD INSURANCE LTD — Licensed composite insurer under the Anguilla Insurance Act (2022) · Registered Office: P.O. Box 941, 201 The Rogers Office Building, Edwin Wallace Rey Drive, George Hill, Anguilla, 2640 · www.skyguardglobal.com
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SkyGuard
DECISION SCHEDULE
Policy no. —
Decision Schedule
Policy
Currency
Premium frequency
Total premium (incl. loadings)
Assumed commencement date
Principal Life Assured
Name
Date of birth
Smoker status
Occupation / Crew role
Licence type
Country of residence
Decision granted at the following terms
Benefit Sum Assured Decision Loadings / Exclusions applied (see Sections B & C)
Section A — Premium Summary
Base premium (ordinary rates)
Health / medical loading
Aviation / operational loading
Country / territorial loading
Total revised premium

All amounts are in USD. SkyGuard is an offshore insurer — no VAT is applicable.

SKYGUARD INSURANCE LTD — Underwriting Counter Offer · Policy no. —
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SkyGuard
LOADINGS & EXCLUSIONS
Policy no. —
Section B — Loadings Imposed

Complete one line per loading. Percentage loadings are extra mortality/morbidity (e.g. +75%); per-mille loadings are a flat extra per 1 000 of sum assured per annum.

Applies to benefit Type Amount Duration Reason
Section C — Exclusions Imposed

Select each exclusion from the drop-down list and add it. New standard exclusions are managed in the Exclusion Library (⚙ toolbar button). Each exclusion carries a reference (C1, H1, O1 …) — quote that reference in the Decision Schedule. No benefit is payable for any claim arising directly or indirectly from an excluded cause, territory or operation.

C — Country / Territorial Exclusions

No cover applies while the Life Assured is flying in, over, to or from — or is physically present in — the listed countries or territories.

RefCountry / territory excluded Applies to benefit(s)Basis / remarks
C1

H — Health / Medical Exclusions

No benefit is payable for any claim arising directly or indirectly from the named condition, its treatment, or its complications.

RefCondition / system excluded Applies to benefit(s)Duration (whole term / review date)
H1

O — Operational / Aviation Exclusions

No cover applies while the Life Assured is engaged in the listed operations, whether as pilot, crew or passenger, unless separately agreed in writing.

RefOperation excluded Applies to benefit(s)Remarks
O1
SKYGUARD INSURANCE LTD — Underwriting Counter Offer · Policy no. —
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SkyGuard
SPECIAL CONDITIONS & DECLARATION
Policy no. —
Section D — Special Conditions
Counter Offer Declaration
  1. If the Applicant/Policyholder accepts the terms of this counter offer without amendment, cover commences on the later of the date SkyGuard receives this counter offer duly signed together with the initial premium, or the commencement date specified in the Decision Schedule.
  2. Please specify any amendments requested to the benefits:

    A request for amendments constitutes a counter offer to SkyGuard and may entail a reassessment of the risk.

  3. Declaration by the Life Assured and the Policyholder:
    I/We declare that since the application was made there has been no material change in the health, occupation, aviation licence status, flying activity or pursuits of the Life Assured, and that no other circumstances have arisen which would materially affect the assessment of the risk. I/We acknowledge that if any such change arises before cover commences, the policy may be declared void unless SkyGuard is immediately informed and the risk reassessed and accepted. If this declaration cannot be signed, full details must be provided below.
By signing below, I/we acknowledge and agree that: (a) SkyGuard has made a counter offer in respect of my/our application; (b) I/we accept the terms, exclusions, loadings and additional premium (if any) contained herein, subject to any amendments requested in Note 2; (c) I/we have read and understood all pages of this counter offer; and (d) this counter offer forms part of the contract of insurance governed by the laws of Anguilla.
Electronic Acceptance
Prefer ink? Leave this section blank, print the letter and sign below instead.
Signed at on this day
Signature of the Life Assured
Signature of the Policyholder (if different)
Signature — SkyGuard Underwriter
Date received by SkyGuard
SKYGUARD INSURANCE LTD — Licensed composite insurer under the Anguilla Insurance Act (2022) · Registered Office: P.O. Box 941, 201 The Rogers Office Building, Edwin Wallace Rey Drive, George Hill, Anguilla, 2640 · This document is confidential and forms part of the contract of insurance once accepted.
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