ࡱ> ~E@ PHbjbj pj<<<<@@@Td<T7.4@t"t"t"t"&(|*`7b7b7b7b7b7b7'9Ry;b7Q@P-_%&P-P-b7<<t"t"7,1,1,1P-<t"@t"`7,1P-`7,1x,11J@1t"( Pw`-L117071<-p<1TT<<<<<@1(*Z3+@,1s+4+***b7b7TT1TTREPORT OF ACCIDENT - AIRCRAFT ACCIDENT Please fill out and return promptly to Northwest Insurance Group, Inc., 3301 NE Cornell Road, Suite R, Hillsboro, OR 97124 Phone: 800-693-7053 Fax: 503-640-6202 Name of Insured FORMTEXT      Policy No. FORMTEXT      Address FORMTEXT      Purpose of Flight FORMTEXT      Date of Accident or Loss FORMTEXT      Hour of Day FORMTEXT      M. Aircraft: Make FORMTEXT      N. # FORMTEXT      Name of Pilot FORMTEXT       FORMCHECKBOX StudentAddress FORMTEXT       FORMCHECKBOX RenterPilot s Certificate: Type FORMTEXT      Rating FORMTEXT       LocationPlace FORMTEXT      ofWeather FORMTEXT      Accident FORMTEXT       FORMCHECKBOX  VFR FORMCHECKBOX  IFR Tell how the accident happened, noting what you saw or heard. FORMTEXT       FORMTEXT       FORMTEXT      (Use back on back of form for additional information and accident diagram.) Names and addresses of all witnesses including persons who inspected place of accident. FORMTEXT       FORMTEXT       FORMTEXT       Name FORMTEXT      Address FORMTEXT      Passenger  FORMCHECRTJ L    " $ 8 : N P R \ ^ ٱٝٱvٱbٱ'jh?'UhA3CJOJQJU'jth?'UhA3CJOJQJU$jh?'UhA3CJUmHnHu'jh?'UhA3CJOJQJU!jh?'UhA3CJOJQJUh?'Uh?'UCJOJQJh?'UCJOJQJh?'UhA3CJOJQJh?'UhA3CJOJQJh?'UhA3CJ$OJQJ RTL & ( 8 ` mkd$$Ifl\@ f!l- 64 la$If$a$$a$ zGNH` b " J P kGkd$$Ifl0 l-!64 la$IfGkd $$Ifl0pl-$64 la   " $ 8 : < F H R V X Z z | ںںںںںncںOں'jh?'UhA3CJOJQJUh?'UhA3OJQJ,jh?'UhA3CJOJQJUmHnHuh?'UhA3CJ OJQJ'jh?'UhA3CJOJQJU'jih?'UhA3CJOJQJUh?'UhA3CJOJQJ$jh?'UhA3CJUmHnHu!jh?'UhA3CJOJQJU'jh?'UhA3CJOJQJUP R T V Z z usmgggg$If$If &dPkdQ$$IflrJ$+l-~ :F64 la      : < > R T d f z | ~ s_'jh?'UhA3CJOJQJU'jfh?'UhA3CJOJQJU'j2h?'UhA3CJOJQJU'jh?'UhA3CJOJQJUh?'UhA3OJQJ$jh?'UhA3CJUmHnHu'jh?'UhA3CJOJQJUh?'UhA3CJOJQJ!jh?'UhA3CJOJQJU%  @ P yssss$If$Ifkd$$Iflr !l-eg 64 laP R T d yssss$If$Ifkd$$Iflr2 #%l-64 la  , T yssss$If$IfkdN $$Iflrp#%l-Z64 la     , . 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