CIVIL AVIATION INSURANCE
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NEEDS ANALYSIS FORM

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 wish to insure
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 Pilot):
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)		 Yes    No

If Yes, please answer the following question:
How much Liability Cover do you require:  
(We recommend a minimum of AUD$500,000
per passenger seat plus $2million Third Party)

        
Section B: Aircraft Uses
  Tick Box Estimated hours of operation 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: Insurance Information
   
 
(dd/mm/yyyy)
(dd/mm/yyyy)
   
Full Ground, Taxi & Flying Risks;
Ground & Taxi Risks Only (non flight)
Static Only (Storage/Long Term Overhaul, etc)
Other:

If Other, please describe:
   
Yes    No

Breach of Warranty is usually required by financiers because regardless of any circumstance that might void your insurance cover this warranty guarantees the financier gets paid out the amount owing on the aircraft up to the maximum sum insured, if the aircraft becomes a write-off.
Section D: Pilot Criteria

This section aims to determine the minimum criteria and standard of pilot experience and proficiency.
   
Yes    No
   
   
Yes    No
Yes    No
 
   
Yes    No

If No, go straight to Section E
If Yes please answer the following 4 questons:
eg. 150 hours
Yes    No
Section E: Proposer Contact Information
   
(include Country and Area Code)
(include Country and Area Code)
(include Country and Area Code)
Section F. Disclosure and Acknowledgement Details
Has the Owner or the Person requesting this Quote ever:-
Yes No
Yes No
Yes No
If Yes to any of the questions above, please give details:

, [Owner, Partner, Principal] 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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