NZ Recreational Insurance Claim

Recreational Insurance Claim
Policy Number
You can find your policy number on your policy schedule/certificate
Policyholder (company name)
Contact Name

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

Street Address

Street Address Line 2

CityState

Postal CodeCountry

Date/Time/Location
When did the incident occur?

MonthDayYear
Date
Time of incident?

Hour Minutes

AM/PM Option
Who was the remote pilot in command at the time of incident?

First NameLast Name
Please provide the address/location of the incident
Please provide the weather conditions at the time
Please provide a detailed description of the incident

Loss & Damage Details

We will need to see a copy of the following documents:
Please provide details of any loss or damage to your Associated Equipment (owned by you)
Please provide details of any loss or damage to any Hired In Equipment (not owned by you)
Please provide details of any third party property damage or injury
Please provide details of any witnesses to the incident

Documents

We will need to see a copy of the following documents:
Pre-flight and on-site survey/Photos or Videos of the Incident/ Copy of Operations Manual or Exposition/Proof Airshare Flight Request/Proof of Purchase & Ownership/Flight Data & Logs (if available)

Cancelof

Declaration

Please confirm the following:
You acknowledge that you understand the contents of this claim form and confirm that the information provided is accurate and complete to the best of your knowledge. You also understand that your information may be shared with regulatory bodies for the purpose of monitoring and/or ensuring our compliance with relevant rules and regulations.

Yes, I confirm
Full name of the person submitting this claim form:

First NameLast Name
Please verify that you are human*
Should be Empty:

Recreational Insurance Claim