On-line Home Warranty Insurance Job Specific Policy Application

Thank you for considering our on-line home warranty insurance service.    Because Greater National Group is an insurance broker, not an insurance company, we will process your application with major insurance companies in order to find the right home warranty insurance for you.

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond with your terms as soon as we have researched the market for the right available deals that fit your requirements.

This form is to be used where policies are required for contract/s not exceeding $1.5M in value and/or consists of six (6) or less dwellings on the one site. One form must be submitted for each project/development. The ‘Job Specific – Multi-Dwelling Policy Application’ is to be used where policies are required for contract/s exceeding $1.5M in value and/or consists of more than six (6) dwellings on the one site.
Section 1 - Contractor/Builder information
1a. Eligibility no.:
1b. Licence/Registration no.:
Section 2 - Home owner information
2a. Name (if different to the name on the contract, please provide a written explanation):
2b. Current contact address:
2c. Contact telephone no.:
2d. Is there any relationship between the builder and owner (eg. family members, common directorship/shareholding, joint ownership of land, affiliated company, etc)?
Yes No
If "Yes", please provide details:
Section 3 - Site location
Lot no. Unit no's. Street no. Street name Suburb/Town
State Postcode No. of units Shire/Council
3b. Has construction commenced on the project?
Yes No
If "Yes", what is the current stage? (ie. base, frame, lock-up, fit out, completed):
Section 4 - Contract information (NB. contract price must include GST)
4a. Is the project speculative?
Yes No
If "Yes", go to Section 5. If "No", please continue with section 4.
4b. Have you entered into a contract?
Yes No
If "No" Estimated sign date: Estimated contract price: $
If "Yes" Date contract signed: Contract price: $
4c. Type of contract?
Fixed Price contract Cost plus contract
If Cost plus contract Budget: $ Margin % or $:
4d. Estimated start date:
4e. Estimated completion date:
4f. Builder’s contract/Job reference no.:
4g. Has an industry standard contract been utilised for this project (ie. Government Authority/industry Association)?
Yes No
If "Yes", if it has been amended, please state in what way:
4h. Is this an architect/designer tendered project?
Yes No
If "Yes", please provide:
Name of architectural firm Contact name Contact telephone no.
4i. Mortgagee/Interested party?
Section 5 - Speculative development (Please provide a copy of the council Rates Notice)
NB. A project where the Contractor/Builder who owns land carries out residential building work on it.)
5a. Construction Budget: $
5b. Margin % or $:
5c. Estimated start date:
5d. Estimated completion date:
Section 6 - Construction information
6a. Type of construction being undertaken – soil classification details are to be completed below:
Single dwelling
Dwelling improvements — structural
Swimming pool
Unit/duplex/villa: Number of units
Dwelling improvements — non-structural (Scope of Works required)
Other - Details
6b. Does this contract form part of a house and land package (new dwellings only)?
Yes No
6c. Does this contract include construction of a swimming pool?
Yes No
6d. Please provide a brief description of the work being undertaken (i.e. new home, renovation, addition or alteration) and other than for a new home, what rooms/part of the house are affected?
6e. Building materials used in the construction (ie. solid brick, brick veneer, weatherboard, etc):
6f. Roofing materials used in the construction (ie. tile, slate, steel, etc):
6g. Number of storeys:
6h. Living area size:
6i. Garage size:
6j. Will the owner be undertaking any work or supplying any of the materials?
Yes No
If "Yes", please supply details:
6k. Are there any special conditions in the building contract?
Yes No
If "Yes", please supply details:
6l. What is the Soil Classification for this project?
For soil classifications of H, E or P, footings details must be included:
6m. Name of geotechnical engineer/civil engineer who classified the site:
6n. Name of person who engaged this engineer:
6o. Value of any external works included in the contract price:
Paving/Landscaping Fencing/Retaining Walls Other
$ $ $

Duty of Disclosure:
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?
Yes No

If so, please provide details below:
I/We hereby declare that:
My/Our attention has been drawn to the Important Notices accompanying this form and further I/we have read these notices carefully and acknowledge my/our understanding of their content. The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this form and the inception date of the insurance to which this relates I/we shall give immediate notice thereof. I/We authorise GNG and the Insurer to collect or disclose any personal information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact and the Privacy Policy. I/We also confirm that I/we am/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this form and I/we complete this form on their behalf.
Any other comments, requests or relevant information you need to add:
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss quote details in person. Please leave a contact phone number and best time to call to facilitate this.
Your full name:
Company/Business/Name of Applicant to be Insured:
Your phone number (please include area code):
Your mobile phone number:
Best time(s) to call:
Please send my quote by (select at least one):
email phone fax mail
Your email address:
Your website address:
Your fax number:
Your postal address: