Avro Claims Form

Declaration
I hereby declare that the information being submitted in this claim form is true & correct to the best of my knowledge and belief.

Policy & Aircraft Data

Information about policy and insured object
Policy Data
Policy Number (if known)
Policyholder Name*
Insured Aircraft Data
Is an aircraft involved in this claim?

YesNo
Aircraft Make & Model

MakeModel
Registration Prefix*
Aircraft Registration*

Contact Information

Information about notifier
Name (if different from policyholder name)

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number

Loss Information
Date of Loss (please estimate date of loss if exact date is not known)*

DayMonthYear
Date
Hull Damage

YesNo
Property Damage

YesNo
Injuries or Fatalities

YesNo
Fatalities
Number of fatalities
Injuries
Number of persons who got injuries
Please describe what happened in free form *
Place of Loss (Country & Province/State)*

Add files
Add Photos of Damage

Add any photos of damage or other documents you wish to provide at this time.
Cancelof
Should be Empty: