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Mican admin office p. O. Box 993, Rundu, Namibia Cell: 081 143 0464, Fax 066 256695


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APP-AIRREV-01


MICAN ADMIN OFFICE

P.O. Box 993, Rundu, Namibia
Cell: 081 143 0464, Fax 066 256695


http://www.mican.com.na
RENEWAL

AIRCRAFT MPI (AP) AND 3rd PARTY INSURANCE

NAME OF OWNER: .........................................................................................................................................



Registration number of aircraft? ...............................


Type/Make of Microlight/Ultralight: ..............................................................................................................



Fees Payable:

3rd Party Insurance on Microlight: (Cover of N$ 500 000) N$ 450-00 ○

Microlight Annual Inspection Fee N$ 300-00 ○

AMOUNT TO BE PAID FOR AIRCRAFT ONLY N$
**************PLEASE ADD MEMBERSHIP FEE TO THE ABOVE AMOUNT IF APPLICABLE******************


If you have your own 3rd Part Insurance please just send us proof of cover.

Checks must be crossed and made payable to MICAN.

Please note that 3rd Party Insurance is per Microlight and not per pilot.



MICAN BANK DETAILS

(FOR DIRECT DEPOSITS)


Microlight Association of Namibia (MICAN)

First National Bank

Acc No: 62084619223

Branch: 280-472

(Swakopmund)


Please FAX deposit slip together with this form to 066-256695

FOR ATTENTION: Mr. D.A. Oelofse

P. O. Box 993, Rundu, NAMIBIA.

If not done in this manner, payments received will be handled as donations to MICAN.

SIGNATURE OF THE APPLICANT DATE:

­­­­­­­­­----------------------------------------------------- ----------------------------------------------






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