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Policy Start Date

Policy Number

You can find your policy number on your policy schedule/certificate

Policyholder (business name)

This is the 'insured' name on your schedule/certificate.

Contact Name

Your Address

Address Line 1

Address Line 2 (optional)

City

County Name

Postcode

Country

Contact Details

Phone Number

Email Address

Are you VAT registered?

Yes No

Make of Drone

Model of Drone

Does the Drone have a C Class Mark?

This is a letter and number marking on the body of the drone (e.g. C0, C1 etc) to show it has met European Safety Standards. If possible, please upload an image of this marking alongside any documentation.

When did the incident occur?

Time of Incident

Who was the Operator at the time of the Incident?

When did the Operator gain their Permission for Aerial Work?

Address/Location of the Incident

What were the weather conditions at the time?

Detailed description of the Incident

In this section we need details about the loss/damage or injury that has occurred.

Details of loss or damage to Drone(s) owned by you

Please provide details of any loss of 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:

Proof of purchase/ownership
Photos or videos of the incident
Flight data (where available)

If you have any other documents/photos/videos that you think will help to substantiate your claim, please send them to us. If you have large files to send to us, please let us know after submitting them.

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Declaration

Please confirm the following:

You understand the contents of this claim form and you declare that the information given is, to the best of your knowledge and belief, correct and complete. You understand that your information may also be disclosed to regulatory bodies for the purposes of monitoring and/or enforcing our compliance with any regulatory rules/codes

Yes, I confirm that I have read and agree to the terms above.

Name of person submitting this claim form

Position held

Déclarer un sinistre pro

Policy Start Date

Your Address

Contact Details

Documents

Declaration

Contrats

Services

Liens rapides

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