NZ Helicopter Association
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NZHA Safety Recognition Award Online Application

 
Name

First
Last
Indicate the level applied for*


Details of Levels and pricing
 Platinum  
 Gold 
 Silver 
 Bronze 
 
Being a member of the New Zealand Helicopter
Association division of the Aviation Industry
Association, I/We hereby apply to be assessed for
a Safety Recognition Award at the level indicated.
Name to appear on award*
 

Physical Address
Street
Suburb/City
Postcode
 

Postal Address
Suburb/City
Street
Postcode
 
Website
 

Primary Contact
Name

First
Last
Designation
DDI
Mobile
Email
 

Secondary Contact
Name

First
Last
DDI
Mobile
Designation
Email
 

Supporting Documentation

In support of this application please provide the following application. Upload files as required
AIA Membership Code*
Copy of AOC or individual licence
Airworthiness Certificates of Aircraft
registration to appear on the award
Please upload as a single file if more than one
aircraft
Number of hours, or revenue hours operated.
Optional. Please indicate whether you want this to
appear on certificate
Include on Certificate
 Yes, include it on the certificate 
Date of incorporation of company, or commencement of operation
 
Contact details of insurance company

Please attach any other supporting documents below that you believe will be useful in the assessment process
Other
Other
Other
Please check the box to indicate you agree to the terms and conditions relating to the Safety Recognition Awards*
 I agree 
 
 
Name*

First
Last
Date*

MM		 /
DD		 /
YYYY
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