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MULTI AIRCRAFT FORM NEEDS ANALYSIS FORM

Please complete all required fields. They have been highlighted in red for your convenience.
Section A: Operator Information
   
Yes    No
   
   
Yes    No

   
   
   
 
Other
TOTAL
Section B: Aircraft Fleet Uses
  Tick Box Estimated hours of operation for the next 12 months
Charter - Passenger & Freight, Cargo & Airwork
Regular Public Transport
Flying Training including Abinitio
Private Hire & Cross Hire
Medi-Vac and Air Ambulance
Agricultural (non mustering)
Mustering of Livestock
Crop Dusting & Chemical Spraying
If Other
Please describe Other
 TOTAL HOURS
Section C: Pilot Criteria

This section aims to determine the minimum criteria and standard of pilot experience who will operate the aircraft.
   
eg. 500 hours
   
Yes    No
Section D: Aircraft Schedule - please complete details concerning each Aircraft in the Fleet
Aviation Insurance Australia :: Aircraft Helicopter Insurance
HideDetails Aircraft #1
Type of Aircraft:
Experimental/Amateur Built: Yes No
Aircraft Make and Model:
Registration Number:  
If other:
Year of Manufacture:
Number of Engines: 1    2    3
Type of Engines: Piston    Turbine    Jet
Number of Seats (Not including Pilots):
Is the Aircraft Usually Hangared: Yes    No
Would you like to insure the Aircraft Hull: Yes    No
If Yes, please answer the following question:
How much do you want to Insure the Hull for:  
Would you like to insure for Third Party Liability:
(including passengers - Carriers Liability Act)		 Yes    No

If Yes, please answer the following question:
How much Liability Cover do you require:  
(We recommend a minimum of AUD$2million)

        
Section E: Insurance Information
   
 
   
(dd/mm/yyyy)
   
(dd/mm/yyyy)
   
Yes    No
Yes    No
 
Section F: Operator Contact Information
   
(include Country and Area Code)
(include Country and Area Code)
(include Country and Area Code)
Section G. Disclosure and Acknowledgement Details
Has the Proposer or it's Chief Pilot ever:-
Yes No
Yes No
Yes No
If Yes to any of the questions above, please give details:

, [Partner, Principal, Director] of the Proposer, hereby declare and warrant: -

  1. I am authorised to complete this Proposal on behalf of the Proposer; and;
  2. I have read and understand my obligations of duty of disclosure under the Insurance Contracts Act 1984 and have made enquires to ensure all answers to the questions contained in this Proposal are true and correct to the best of my knowledge and belief and that no information whatsoever has been withheld; and
  3. I have read and agree to the 'Terms & Conditions' relating to this Proposal, including matters concerning the 'Privacy Act' and how the information I have provided might be used; and
  4. I understand that the submission of this Proposal does not bind or obligate any party to enter into a binding contract of insurance.
I, agree to the above terms       Yes         No

Note: If insurance terms are provided to the Proposer, and the Proposer accepts the terms and wishes to proceed with the insurance cover, the Proposer may be required to physically sign a copy of the Proposal before insurance cover is provided.


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