NZ Commercial UAV Insurance Form

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Date

MonthDayYear
Date
Commercial UAV Insurance Proposal
Applicants Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Name of Insured*
Address*

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Are you GST registered?*

YesNo
GST Number*
Insurance Start Date*

DayMonthYear
Date
Do you currently have an insurance provider?*

YesNo
Current Insurer*
Business or Occupation*
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UAOC Verification
Does your company hold (or will hold by the time you commence operations) a valid Unmanned Aircraft Operator Certificate?*

YesNo
Upload your UAOC (Unmanned Aircraft Operator Certificate)*

Cancelof
Please list the privileges will you be utilising outside of the Part 101 rules as per your company Exposition (e.g., BVLOS, night operations unshielded, operations of aircraft greater than 25kg, etc.)*
Upload your company Operations Specifications (Ops Specs)*

Cancelof
Will your pilots be operating under another company’s Unmanned Aircraft Operator Certificate?*

YesNo
Upload the UAOC of the company your pilots will be operating under*

Cancelof
Please list the privileges will you be utilising outside of the Part 101 rules as per the company Exposition your pilots will be operating under (e.g., BVLOS, night operations unshielded, operations of aircraft greater than 25kg, etc.)*
Upload the company Operations Specifications (Ops Specs) your pilots will be operating under*

Cancelof
💾 Note: You can save your progress at any time. A resume link will be sent to your inbox so you can continue later.

RPAS Register*

	Make/Model	Serial Number	Maximum Take Off Weight (kg)	Value NZD(Excluding GST)	Estimated Hours of Operation in the Next 12 Months?	Tethered or Non-Tethered?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Will any of these RPAS be operated beyond visual line of sight (BVLOS)?*

YesNo
Maximum number of RPAS in the air at any one time?*
Third Party Limit of Liability Required:*

$10,000,000$20,000,000Other
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Equipment/Payload Register*

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Pilot Register*

	Name	Total UAV Flight Time (Hrs) Please specify the RPAS type(s) and model(s) flown:	Licenses/Qualifications
1.
2.
3.
4.
5.
6.
7.

Upload Pilot Licenses/Qualifications*

Cancelof
Will you be carrying out operations overseas?*

YesNo
Tick that apply:*

AustraliaPacific Islands
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Convictions
Have you or any of the above operators been convicted of a breach of air navigation safety regulations?*

YesNo
If yes, please provide details.*
Has any operator named above been convicted of driving a motor vehicle under the influence of drugs or alcohol during the last 5 years?*

YesNo
If yes, please provide details.*
Has any operator named above ever had their license suspended or cancelled?*

YesNo
If yes, please provide details.*
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Previous Insurance
Have you (or a corporation of which you were a director or, if the proposer is a corporation, a person who is a director of the proposer) previously held an aircraft or RPAS insurance policy?*

YesNo
Insurer Name*
Policy Number*
Has any insurer cancelled, declined or refused to renew any such insurance policy?*

YesNo
Please provide details.*
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By submitting this form...

You agree that we may use the information provided to contact you regarding your quote. We may reach out to you via phone, email, or other means to provide further assistance. Your submission indicates your consent for us to store and process your information for the purpose of providing the requested quote and related services.
Applicants Name*
Date*

MonthDayYear
Date
Applicants Signature*

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Commercial UAV Insurance Proposal