Form – Aviation (HKL) Liability Insurance Renewal Questionnaire Proposer DetailsName(Required) Name Insured (if different from Name) Nature of Interest Address State Postcode Postal Address (if different from Address) State Postcode Contact DetailsEmail(Required) Telephone(Required) Mobile(Required) Period of Insurance To both days at 4pm Local Time of the InsuredType of Business(please) fully review below and confirm that the description encompasses all of your operations / services)(Required) Location(/s)Location(Required) Do you have operation outside of Australia? Yes No if yes, please advice where these operations are located(Required) Present LimitsSection 1 Premises Liability any one occurrenceSection 2 Hangarkeepers Liability Aircraft or aircraft equipment in your care/custody/control any one occurrenceSection 3 Products Liability Aircraft or aircraft equipment having your care/custody/control any one occurrence and in the annual aggregateInformation Required 1. If amendment to limits of cover is required, please indicate your preferred limits below:Section 1 Premises Liability any one occurrenceSection 2 Hangarkeepers Liability Aircraft or aircraft equipment in your care/custody/control any one occurrenceSection 3 Products Liability Aircraft or aircraft equipment having your care/custody/control any one occurrence and in the annual aggregate2. Gross turnover for the last twelve months split over Labour and Parts:Labour(Required) Parts(Required) 3. Gross Turnover for the forthcoming twelve months split over Labour and Parts:Labour(Required) Parts(Required) 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? Yes No If yes, what percentage of the annual turnover is on turbines?(Required) 7. Do you work on helicopters? Yes No If yes, what percentage of the annual turnover is on turbines? 8. Do you test fly aircraft after maintenance? Yes No If yes, do you require the policy to be extended to incorporate the risk (this may incur additional premium) Yes No 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?Engineering LAME(Required) Management(Required) Sales(Required) Engineering Other(Required) Office Staff(Required) Other 11. Do you supply fuel to third parties? Yes No If yes, what is the approximate annual amount in litres?(Required) 12. Do you or any of your directors or employees temporarily travel overseas on behalf of the Insured’s business? Yes No If yes, please provide details of countries these persons will visit and the estimated number of days they will by away from Australia(Required) 13. Do you sell any aircraft or aircraft components overseas? Yes No If yes, we will require a separate Aviation Products Liability Questionnaire to be completed.(Required) 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 cause of the loss is found to be resulting from your maintenance work, then your Products Liability insurance will not provide indemnity.14. Do you own, lease or occupy any premises? Yes No If yes, please list and identify the premises you own, lease or occupy:Premises(Required) Occupy PremisesOwnLeaseOccupyPremises(Required) Occupy PremisesOwnLeaseOccupyPremises(Required) Occupy PremisesOwnLeaseOccupy15. Do you own or operate any mechanically propelled vehicles, mobile plant or ground service equipment airside? Yes No If yes, please list all vehicles operating within airport boundaries:RegistrationMakeModelPurpose of UseEstimated days p.a. Add Removea. Estimated number of vehicles operating at any one time? b. Do vehicles operate within 50m of aircraft? Yes No 16. Do you engage any subcontractors for labour only? Yes No If yes, please give details of the work performed by them:(Required)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) Yes No 18. Are you aware of any incidents or accidents that may give rise to a claim under your policy? Yes No If yes, please provide details:(Required)
