Aviation (HKL) Liability Insurance Renewal Questionnaire (Premises, Hangarkeeper’s and Products Liability) Proposer Details Contact Details Period of Insurance to both days at 4pm Local Time of the Insured Type of Business (please) fully review below and confirm that the description encompasses all of your operations / services) Location(/s) Do you have operation outside of Australia? YesNo if yes, please advice where these operations are located Present Limits Section 1 Premises Liability any one occurrence Section 2 Hangarkeepers Liability Aircraft or aircraft equipment in your care/custod/control any one occurrence Section 3 Products Liability Aircraft or aircraft equipment having your care/custod/control any one occurrence and in the annual aggregate Information Required 1. If amendment to limits of cover is required, please indicate your preferred limits below: Section 1 Premises Liability any one occurrence Section 2 Hangarkeepers Liability Aircraft or aircraft equipment in your care/custod/control any one occurrence Section 3 Products Liability Aircraft or aircraft equipment having your care/custod/control any one occurrence and in the annual aggregate 2. Gross turnover for the last twelve months split over Labour and Parts: Labour Parts 3. Gross Turnover for the forthcoming twelve months split over Labour and Parts: Labour Parts 4. Aircraft sales during the last twelve months: 5. Anticipated aircraft sales for the next twelve months: 6. Do you work on turbine fixed wing aircraft? YesNo If yes, what percentage of the annual turnover is on turbines? 7. Do you work on helicopters? YesNo If yes, what percentage of the annual turnover is on turbines? 8. Do you test fly aircraft after maintenance? YesNo If yes, do you require the policy to be extended to incorporate the risk (this may incur additional premium)YesNo 9. Total value of aircraft other than your own which may occupy the company hangar(s) at any one time? Total Value: Maximum Value any one aircraft: 10. Number of staff employed? 11. Do you supply fuel to third parties? YesNo If yes, what is the approximate annual amount in litres? 12. Do you or any of your directors or employees temporarily travel overseas on behalf of the Insured’s business? YesNo If yes, please provide details of countries these persons will visit and the estimated number of days they will by away from Australia 13. Do you sell any aircraft or aircraft components overseas? YesNo If yes, we will require a separate Aviation Products Liability Questionnaire to be completed. IMPORTANT NOTE: The below insurers have exclusions relating to USA and/or Canadian laws and court proceedings, judgements etc. as detailed below: Insurer Policy Exclusion Agile Aviation THIS POLICY DOES NOT COVER liability arising out of, created or determined by the laws, statutes or tribunals of the United States of America or Canada or any judgment obtained in the United States of America or Canada. QBE Aviation THIS POLICY DOES NOT COVER liability arising out of, created or determined by the laws, statutes or tribunals of the United States of America. Swiss Re THIS POLICY DOES NOT COVER liability arising out of, created or predetermined by the laws, statutes or tribunals of the United States of America or its territories. Please be aware that Insured’s who have products (aircraft or aircraft components) that enter USA or Canadian jurisdictions without your knowledge e.g. sale of a one of your customers aircraft post maintenance undertaken by your organisation to a US operator. If that aircraft is involved in an accident in the USA or Canada and the caus 14. Do you own, lease or occupy any premises? YesNo If yes, please list and identify the premises you own, lease or occupy: Premises OwnLeaseOccupy Premises OwnLeaseOccupy Premises OwnLeaseOccupy 15. Do you own or operate any mechanically propelled vehicles, mobile plant or ground service equipment airside? YesNo If yes, please list all vehicles operating within airport boundaries: Registration Make Model Purpose of Use Estimated days p.a. a. Estimated number of vehicles operating at any one time? b. Do vehicles operate within 50m of aircraft? YesNo 16. Do you engage any subcontractors for labour only? YesNo If yes, please give details of the work performed by them: 17. Do you wish to include their (subcontractors) liability for services provided to you by them under your insurance? (this is of course subject to Insurers agreement) YesNo 18. Are you aware of any incidents or accidents that may give rise to a claim under your policy? YesNo If yes, please provide details:
