Helicopter Insurance Proposal Form

Helicopter Insurance Proposal Form

If insufficient space provided please identify and attach separate sheet(s)

Name of Insured
Address of Insured
Contact Name
Telephone Number
Facsimile Number
E-mail
Senior Executive (Chairman, MD, etc)
Chief Pilot
Chief Engineer
Types of Licences Held
Who handles day-to-day Insurance matters

Details of Aircraft

Number of aircraft to be proposed

(Please attach additional sheets if insufficient space provided)

Operational Information

1. / Main areas of operation
2. / Location of bases
3. / If any operations expected outside country of domicile please describe fully
4. / Fleet changes expected in the next 12 months (Additions and deletions of aircraft – purchases, etc)
5. / Who will be maintaining the aircraft
6. / Main or chief operations of flying
7. / Type of operation / Regular / Infrequent / Not Anticipated
a) / People transport
b) / Cargo – internal
c) / Cargo – external
d) / Exploration (oil and mineral) onshore
e) / Aerial construction
f) / Survey/seismic operation
g) / Forestry Patrol
h) / Forestry Fire control/support
i) / Forestry Logging/shakes
j) / Forestry Other
k) / Power/pipeline patrol
l) / Agricultural operations
m) / Air ambulance/medical
n) / Training – Ab initio
o) / Training – Advanced and recurrent
p) / Traffic reporting / E.N.G.
q) / Aerial photography
r) / Sightseeing
s) / Mountain operations
t) / Instruments
u) / Night flying
v) / Any other – please specify

Fleet Utilisation

1. / Average utilization by aircraft type / 200_ / 200_ / 200_ / Anticipated 200_
a)
b)
c)
d)
e)
2. / Percentage of annual utilization for the following operations (please note does not have to total 100%)
a) / Air ambulance
b) / Crew changes
c) / Fire fighting
d) / Forestry control
e) / Heli skiing
f) / Logging
g) / Shake hauling
h) / Mining support
i) / Oil field support
j) / Power/pipeline patrol
k) / Spraying
l) / Surveying
m) / Training Own employees
n) / Training Ab initio (outsiders)
o) / Advanced (outsiders)
p) / Other please specify
q) / Slung loads

Pilot Details

Number of pilots to be proposed

(Please attach additional sheets if insufficient space provided)

1. / Name
2. / Age
3. / Total time Fixed/Rotary
4. / RW Turbine
5. / Hours last
6. / Principal Aircraft Type will fly
7. / Hours on
8. / Describe any accidents past five years
9. / Give brief description of producers you use to keep pilots current and checked out (i.e. recurrent training programmes, etc,)
10 / Are your pilots usually full time (i.e. on staff all year) or do you generally hire on demand
11. / If hired on demand do you find you usually get the same pilots back each year

Contractual

1. / Advise the loss payees (other than named insured) applicable to each aircraft to be insured
(Attach separate sheet if space insufficient)
2. / Special contracts
Describe any special contracts for which recognition is required under your policy and for which certificates are to be filed at inception.

Special Ground Liability Information

1. / Premises Liability
a) / Any locations to be noted other than your bases
b) / Do you lease or own your main bases
c) / Are you the sole occupant of the building
If not, who else shares
2. / Hangarkeepers Liability
a) / Do you regularly store or have in your care aircraft owned by others
b) / If yesMaximum value any one aircraft
Maximum value all aircraft at one time
Do you obtain a waiver from the owner
3. / Products Liability
a) / Indicate your gross receipts from others for any of the following expected in the next 12 months, please state period
i) / Fuel and oil sales
ii) / Aircraft parts
iii) / New aircraft
iv) / Used aircraft
v) / Running maintenance
vi) / Repair and overhaul
b) / Do you do any test flight to customer aircraft
If yes, please state maximum value of aircraft and give type expected.

Miscellaneous

1. / Spares
(Parts and equipment, tools, ground handling, gear, etc.)
a) / Total value of all spares for coverage
b) / Maximum any one location
2. / Non-owned aircraft liability
a) / Annual hours you used aircraft not owned and not insured by you.
3. / Other
a) / Please set out any special coverages other than the standard ones under your insurance policy which you would like to obtain a quote for. Also please express any coverage concerns you may have so we can either quote or give you detailed explanations.
4. / Have you previously held a policy of insurance in respect of this (these) aircraft
If yes, when and with whom
5. / Please state liability limit required.
6. / Has any Insurance company or underwriter
a) / Declined your proposal
If yes, please give details
b) / Cancelled or refused to renew your policy
If yes, please give details
c) / Required an increased premium or revised terms
If yes, please give details
7. / Please give full details of all accidents and/or losses arising during the last five years
If none please state noe

Duty to Disclose Material Information

Material Information is information that would influence an insurer in deciding whether a risk is acceptable and, if so, the premium, terms and conditions to be applied. Failure to disclose such information could result in the policy being rendered void so that claims would not be paid.

The duty of disclosure is re-imposed when there are changes or variations in cover and when the policy is renewed or extended. In addition, changes which substantially increase the risk, or relate to compliance with a warranty or condition in the policy must be notified at once.

To ensure that cover is not prejudiced, please refer to Aon if there is any doubt as to what information needs to be disclosed.

Declaration

I hereby declare that to the best of my knowledge and belief, the particulars and answers herein are true and correct and that I have not knowingly withheld any information which would influence the decision of the underwriters in regard to this proposal.

It is understood and agreed that this proposal shall form the basis of the contract should a policy be issued.

Name:
Signature: / Date:

Attachment of

Additional Aircraft Details

1. / Manufacturer
2. / Type and Variant
3. / Year of Manufacture
4. / Date of Expiry and Category of C of A
5. / Licensed/Declared passenger seating capacity
6. / Registration marks
7. / Date of purchase
8. / Present value
9. / Details of all avionics and accessories e.g. radio/navigational equipment etc.
10. / Total value declared for insurance purposes
11. / Third party interest in aircraft e.g. Bank/Finance House
1. / Manufacturer
2. / Type and Variant
3. / Year of Manufacture
4. / Date of Expiry and Category of C of A
5. / Licensed/Declared passenger seating capacity
6. / Registration marks
7. / Date of purchase
8. / Present value
9. / Details of all avionics and accessories e.g. radio/navigational equipment etc.
10. / Total value declared for insurance purposes
11. / Third party interest in aircraft e.g. Bank/Finance House

Attachment of

Pilot Details

Number of pilots to be proposed

(Please attach additional sheets if insufficient space provided)

1. / Name
2. / Age
3. / Total time Fixed/Rotary
4. / RW Turbine
5. / Hours last
6. / Principal Aircraft Type will fly
7. / Hours on
8. / Describe any accidents past five years
1. / Name
2. / Age
3. / Total time Fixed/Rotary
4. / RW Turbine
5. / Hours last
6. / Principal Aircraft Type will fly
7. / Hours on
8. / Describe any accidents past five years

Helicopter Insurance Prop Form v1.docPage 1 of 1104/12/2018