Aviation Claim

Insured

Insured First Name *
Insured Last Name *
Insured Contact *
Insured Contact E-Mail *
Insured Address (line 1)
Insured Address (line 2)
Insured Address (line 3)
Insured Tel (Work)
Insured Tel (Home)
Insured Tel (Cell)
Insured Policy No
Insured Vat No
Exact Type of Aircraft
Aircraft Reg No
Please leave this field empty.

Accident

Accident Date
Accident Time
Accident Flight Conditions ---DayNight
Visual Flight Rules
Instrumental Flight Rules
Origin of Flight (Airport)
Purpose of Flight
Destination of Flight (Airport)
Place of Accident

Certificate of Registration

Owner First Name
Owner Last Name
Owner Address (Line 1)
Owner Address (Line 2)
Owner Address (Line 3)
Owner Tel (Work)
Owner Tel (Home)

Certificate of Airworthy and Technical Records

Category of Cert of Airworthy / LAMS Schedule ---PrivatePublicTransportSpecialCategoryPermittoFlyOther
Date of Last Issue
Date of Expiry
Make of Aircraft
Serial Number
Registration Marks
Year of Manufacture
Total Hours Since Manufacture
Hours at Certificate of Airworthy
At Inspection: Type
Inspection Date
Right Engine - Serial No. 1
Right Engine - Hours Since Last Overhaul
Right Engine - Since Last T.O.H.
Left Engine - Serial No. 1
Left Engine - Hours Since Last Overhaul
Left Engine - Since Last T.O.H.
Right Propeller - Serial No. 1
Right Propeller - Hourse Since Last Overhaul
Right Propeller - Date of Last CAA Notice 75 Inspection
Left Propeller - Serial No. 1
Left Propeller - Hourse Since Last Overhaul
Left Propeller - Date of Last CAA Notice 75 Inspection
Hours Permitted by Authorities Between Complete Overhauls

Crew Licences and Personal Flying Log Books

If Crop Sprayer: Hours of Pilot on Fixed Wing Agg. [Hours]
If Glider Tug: Hours of Glider Towing Hours [Hours]

General

Can You Reclaim All VAT Incurred With Respects Subject Aircraft Under This Return ---YesNo
If No, Please Explain
Details of Meteorological Forecast Prior to Flight
Meteorological Forecast - From Where
Meteorological Forecast - Time Obtained
Details of Weather Conditions at Time of Accident
State max. permitted A.U.W
State actual A.U.W
Permitted All Up Weight
Actual All Up Weight
Cost Estimates ---InsituteProtectionRecoveryProtectiontoPlaceofSafetyorRepairStorageCharges
Explain Relationship of Pilot to Assured
Details of Any Third Party Injuries Sustained
Any Parties Listed Have Interest in Aircraft (Not Noted on the Policy) ---NoneIndividualCompanyBankFinanceHouse
If Any of the Above Were Selected, Please Supply Details (Name, Address, Contact Phone, Contact Fax)
If Any Other Party Responsible For Accident, Please Supply Details of Actions Taken and Forward Ccopies of Correspondence
Cost (in SA Rands)
What Payment Was made For use Of The Aircraft (in SA Rands)
Was The Aircraft Flown With the Assureds Approval ---YesNo
State The Names and Contact Details of the Passengers

Accident Circumstances

Exactly How Did The Loss Occur