Aviation Insurance Australia :: Aircraft Helicopter Insurance

CIVIL AVIATION INSURANCE

[Australia]

AUSTRALIA NEW ZEALAND - ASIA PACIFIC AVIATION INSURANCE
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Civil Aviation Insurance Non-Owner Liability Online Quote Request

NEEDS ANALYSIS FORM

You need to specify each aircraft you will fly/operate to obtain Non-ownership Liability Insurance

Please complete all required fields. They have been highlighted in red for your convenience.

Section A: Aircraft Schedule - please complete details for each Aircraft you require cover for

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:
Number of Engines:	1 2 3
Type of Engines:	Piston Turbine Jet
Number of Seats (Not including Pilot):
How much Non-Ownership Liability Cover do you require:	(We recommend a minimum of AUD$500,000 per passenger seat plus $2million Third Party)

Section B: Aircraft Uses - how will you be flying/operating the covered aircraft

	Tick Box	Estimated hours you will fly/operate the aircraft for the next 12 months
Private Business & Pleasure
Private Hire & Cross Hire
Training (Owner and Friends, etc)
Charter
Airwork
Agricultural (farm uses non mustering)
Mustering of Livestock
Overwater Flights (5nm or more from land)
Aerobatic & Competition
Other

Please describe Other

Section C: General Information


What Airfield/Base will you mainly operate from:
What date do you want the insurance to start:	(dd/mm/yyyy)

Do you require the insurance to cover:	Full Ground, Taxi & Flying Risks; Ground & Taxi Risks Only (non flight) Static Only (Storage/Long Term Overhaul, etc) Other: If Other, please describe:

Section D: Pilot Information


Is the person making this application a licensed pilot:	Yes No
If Yes, what is your license number:

How many In Command hours do you have:

Have you had any Accidents, Incidents or Claims:	Yes No
or been prosecuted for breaches of Air Law:	Yes No
	If Yes to any of the 2 questions above, please give details:

Section E: Proposer Contact Information


What is your name - 'The Proposer
Address for correspondence:
City:
State:
Postcode (Zipcode):
Country:
Business Hours Telephone:	(include Country and Area Code)
After Hours Telephone:	(include Country and Area Code)
Fax Number:	(include Country and Area Code)
Email Address:

Section F. Disclosure and Acknowledgement Details

Have you, the Proposer, ever:-
a) been refused insurance:	Yes	No
b) had an insurance claim of any type refused or reduced:	Yes	No
c) been charged with a crime of any type:	Yes	No
If Yes to any of the questions above, please give details:

I, the Proposer, hereby declare and warrant: -

I am authorised to complete this Proposal on behalf of the Proposer; and;
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
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
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.

Is there anything more you would like to tell us?

Please complete all required fields. They have been highlighted in red for your convenience.

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