subject_line
First Name
Last Name
*
Date of Birth of Oldest Insured
+
Street
*
City / Suburb
*
PostCode
*
Occupancy type
Owner Occupied
Renting
Weekender/Holiday Home
Building type
*
Free standing home
Townhouse
Terrace
Apartment
Semi Detached/Duplex/Triplex/Quadplex
Flat / Unit
Holiday Home
Granny Flat
Nursing Home Unit
Strata Complex
Window Secruity
Window Bars
Window Key Locks
No Opening Windows
Alarm
No Alarm
Monitored
Local
Deadlocks
Doors
None Fitted
Age of Building
Building Stories
Walls
Asbestos
Brick
Brick Veneer on timber frame
Concrete / Stone
Fibre Cement
Metal
Other Mixed (fully or partly combustible)
Other Mixed (non-combustible)
Plastic Fiberglass
Wood / Particleboard
Roof
Asbestos
Clay Tile / Cement Tile
Concrete / Stone
Fibre Cement
Metal
Wood / Particleboard
Floor
Concrete
Iron / Steel
Brick
Wood
Other/Mixed(Non Combustible)
Other/Mixed(Full/Partial Combustible)
Tile
Is any business conducted from the home?
Yes
No
Cover Details
Cover Type
*
Building and Contents
Building Only
Contents Only
Insurance Required Building
If you are unsure of the replacement
value of your property
please use this calculator
Click Here
Content Sum Insured
If you are unsure of the replacement
value of your contents
please use this calculator
Click Here
Building Excess Option
100
200
300
400
500
600
700
750
800
900
1000
1250
1500
1750
2000
2500
3000
3500
4000
4500
5000
10000
Content Excess Option
100
200
300
400
500
600
700
750
800
900
1000
1250
1500
1750
2000
2500
3000
3500
4000
4500
5000
10000
Do you Require Cover for Specified Items Any items exceeding $1000?
Yes
Specified Items: Any items exceeding $1000 to be insured
Please provide - Description Type Sum Insured
Currently Insured
Yes
No
Current Insurer
Current Premium
Underwriting Acceptance Criteria
Have you been declined insurance in the past 12 months?
Is the property
- used for business purposes that feature the running of industrial machinery?
- under construction, reconstruction or renovation? - not well maintained or in good condition?
- expected to be unoccupied for more than 90 continuous days during the period of cover?
- under any heritage listing/National Trust listing or order?
Yes
No
Underwriters consideration & Comments (please provide details)
Claim in the last 5 years
Yes
No
Claim Details
Declaration: I/WE HEREBY DECLARE AND WARRANT that the answers given above are in every respect true and correct, and that I/We have not withheld any information within My/Our knowledge likely to affect the decision of the Company as to My/Our eligibility for insurance. This request and declaration shall be the basis of the quote request.
*
Yes
No
Contact Info
Phone
*
Email
*
Best time to Call
Call Me Now
08:00-09:00
09:00-10:00
10:00-11:00
11:00-12:00
12:00-13:00
13:00-14:00
14:00-15:00
15:00-16:00
16:00-17:00
17:00-18:00
18:00-19:00
19:00-20:00
Additional Information