On-line Home Warranty Insurance 'Eligibility' Application for New Builders


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.


Section 1 - Business information
1a. Does your business (the applicant) trades as a:
Sole Trader Partnership Company
1b. Trading name(s) (copy of the Certificate of Business Registration must be provided - please see Question 12):
1c. ACN:
1d. What date did this business commence trading?
1e. Is the builder a subsidiary of another entity?
Yes No
If Yes, please provide details of your business structure:
1f. Trade Association membership(s)?
H.I.A M.B.A Other - Please specify
1g. Membership No’s?
1h. States/Territories of operation:
NSW VIC QLD SA WA TAS NT ACT
1i. State in which Eligibility is being sought:
NSW VIC SA WA TAS
If the Applicant requires Eligibility in more than one State, please submit a separate form for each respective State.
Section 2 - Builder Licence/Registration/Accreditation
2a. Name as shown on Building Licence - New South Wales and Western Australia (copy required - Please see Question 12):
2b. Licence no.:
2c. Date Licence first issued:
2d. Name as shown on Designated Practitioner‘s Building Registration/Accreditation – Victoria and Tasmania (copy required - Please see Question 12):
2e. Registration/Accreditation no.:
2f. Date Registration/Accreditation first issued:
2g. Name/s as shown on Contractors licence - South Australia (copy required - Please see Question 12):
2h. Licence no.:
2i. Date Licence first issued:
Section 3 - Financial systems/reporting
3a. If known, qualified Accountant's details (who will prepare the Financial Statements for the business)
3b. Contact name:
3c. Telephone no.:
3d. Facsimile no.:
3e. What type of job costing system do you propose to use?
Manual Industry Standard Software Package Customised Software Package
If you specified Industry Standard Software Package or Customised Software Package, please specify the package:
3f. Do you intend to claim 100% of your input tax credit entitelment for the GST applicable to future policy premiums?
Yes No
If No, please advise what percentage you intend to claim: %
Section 4 - Business and personal background information
4a. Has any director, partner, proprietor, shareholder or manager of your business been involved with a business (including the applicant) where the Statutory building dispute Tribunal has made an order for rectification or payment?
Yes No
4b. Has any director, partner, proprietor, shareholder or manager of your business ever been a director, partner, proprietor, shareholder or manager of a business placed in external administration, a scheme of arrangement, receivership, liquidation or provisional liquidation?
Yes No
4c. Has any director, partner, proprietor, shareholder or manager of your business ever been declared bankrupt, entered into a deed of assignment, composition, scheme of arrangement with creditors, or been subject to a legal judgment or currently have legal proceedings pending?
Yes No
4d. Do you know of or have any information of a ‘material’ nature (i.e. important, significant, relevant) not disclosed within this ‘Eligibility’ application that could affect the financial position, capital structure or operation of the Applicant? (i.e. this may include contingent liabilities, litigation, etc.) Information is ‘material’ if its non-disclosure could influence ‘Eligibility’ acceptance/ decisions that Greater National Group might make on the basis of the information provided.
Yes No
4e. Has any director, partner, proprietor, shareholder or manager of your business ever had a builder’s licence/registration/accreditation refused, cancelled or suspended in any state or territory in Australia?
Yes No
4f. Has any director, partner, proprietor, shareholder or manager of your business ever been a director, partner, proprietor, shareholder or manager of any business which has ever held home warranty insurance with another Warranty Insurer? (If so, please attach a copy of evidence of Warranty ‘Eligibility Limit’ with the most recent Insurer. Please see Question 12)
Yes No
4g. Is your business currently insured with another Home Warranty Insurer for any ongoing construction work? If yes, please provide a copy (please see Question 12) of your current approved ‘Eligibility Limit’, together with a Work in Progress Report. The Work in Progress Report needs to detail all current contracts insured by your current insurer including: the site address, date work commenced (or due to commence), contract value, stage of work completed, estimated completion date and estimated cost to complete.
Yes No
4h. Has a prior home warranty insurer ever paid a claim in respect of your business or any other business for which a director, partner, proprietor, shareholder or manager of your business was involved?
Yes No
4i. Is any director, partner, proprietor, shareholder or manager of your business aware of any circumstances that may give rise to a claim? (e.g. any notification of a claim from your current or prior Home Warranty Insurer.)
Yes No
4j. Is any director, partner, proprietor, shareholder or manager of your business aware of any Court, Tribunal or arbitration hearing involving or in any way related to residential home building work undertaken by your business?
Yes No
4k. Has any director, partner, proprietor, shareholder or manager of your business ever been a director, partner, proprietor, shareholder or manager of a business that has had:
  • an application for Home Warranty Insurance rejected or declined by an Insurer;
  • been refused renewal of an Annual Home Warranty Policy or Job Specific ‘Eligibility’;
  • had their Job Specific ‘Eligibility’ withdrawn.
Yes No
4l. Has your business or any director, partner, proprietor, shareholder or manager of your business or any related parties or businesses given any form of security to another Home Warranty Insurer (e.g. Deed of Indemnity/Assurance, Bank Guarantee, Personal Guarantee or similar document)?
If yes, please advise when the security was provided, the name of Insurer to whom it was provided and the amount of any Bank Guarantees.
Yes No
If you answered "Yes" to any of the questions in Section 4, please provide details:
Section 5 - Proposed construction turnover for the next 12 months
Project Categories $ Number
Residential Insurable Contracts (contracts $12,000 and above)
Residential Non-Insurable Contracts (contracts below $12,000)
Residential Speculative Projects (A Speculative project is where the Contractor/Builder who owns land carries out Residential Building Work on it).
Subcontracting or other Income. Please specify the details and source of other income.
Total Business Turnover
Section 6 - Non-Structural Turnover for the next 12 months
This section is to be completed by applicants who require HWI for Non-Structural Improvements only.
6a. Total estimated insurable non-structural construction for the next 12 months (contracts $12,000 and above ): $
6b. Total estimated non-insurable non-structural construction for the next 12 months (contracts below $12,000): $
6c. Estimated largest non-structural contract for the next 12 months: $
Note: Contract price is to be GST inclusive
Section 7 - Directors/Partners/Proprietors of business - personal details
7. Director/Partner 1
Name: Date of Birth:
Home Address: Home Telephone No.:
Licence,Registration
or Accreditation
no. of this individual (if applicable):		 Licence issued: 
Your building experience over the past 5 years other than as a director/proprietor of this business, if any:
Name of business: Position held:
Dates position held from: to:
Name of business: Position held:
Dates position held from: to:
Trading name(s) of any prior business(es) conducted by this Proprietor:
Please provide evidence of your most recent employment (i.e. copy of Group Certificate or Tax Return - Please see Question 12):
Company: Title:
Year started: Year finished:
Director/Partner 2
Name: Date of Birth:
Home Address: Home Telephone No.:
Licence,Registration
or Accreditation
no. of this individual (if applicable):		 Licence issued: 
Your building experience over the past 5 years other than as a director/proprietor of this business, if any:
Name of business: Position held:
Dates position held from: to:
Name of business: Position held:
Dates position held from: to:
Trading name(s) of any prior business(es) conducted by this Proprietor:
Please provide evidence of your most recent employment (i.e. copy of Group Certificate or Tax Return - Please see Question 12):
Company: Title:
Year started: Year finished:
Director/Partner 3
Name: Date of Birth:
Home Address: Home Telephone No.:
Licence,Registration
or Accreditation
no. of this individual (if applicable):		 Licence issued: 
Your building experience over the past 5 years other than as a director/proprietor of this business, if any:
Name of business: Position held:
Dates position held from: to:
Name of business: Position held:
Dates position held from: to:
Trading name(s) of any prior business(es) conducted by this Proprietor:
Please provide evidence of your most recent employment (i.e. copy of Group Certificate or Tax Return - Please see Question 12):
Company: Title:
Year started: Year finished:
Section 8 - Company Applicants - main shareholders (if applicable)
8.
Name(s) Shareholding
%
%
%
Section 9 - Building qualifications
9. Please provide details of all the qualifications you have obtained and courses you have successfully completed in relation to the building industry. Copies of your Certificates must be provided to substantiate your advices. (Please see Question 12).
Description of Course Qualification Obtained Institute Year completed
Section 10 - Building experiences and references
10. Please list details of the 3 largest construction projects you have been involved with in the past 3 years.
Description of Project Contract value Role on this site
(Contractor/project manager/
site supervisor, etc.)		 Year completed
$
$
$
Please attach a copy of the technical letters or references provided to the licensing/registration/accreditation authority in your State. Please see Question 12
Section 11 - Statement of personal financial position
11. Please complete this for each Director, Partner and Proprietor of the Business. (If insufficient space, please provide the information as an email attachment - please see Question 12)
a. Name of business:
b. ABN:
c. Name of person(s) to whom this statement relates:
11d.
Assets Estimated value
Real estate
Residential home located at:  
$
Other property/vacant land located at:  
$
$
$
$
Motor vehicles
Make, model & year  
$
$
$
Cash at bank
Name of bank  
$
$
$
Other investments (Type of Asset e.g. shares etc)  
$
$
$
Plant & machinery/tools of trade (Type of Asset)  
$
$
$
Work in progress - less Progress Payments already received (for completion by sole traders only) $
Trade debtors (for completion by sole traders only) $
Other monies owed to you (Name of borrower & repayment terms) $
Total Assets $
11e.
Liabilities Amount owing
Mortgages/Secured Property loans
Lender Name Loan Type Property No. (as listed in Assets Column)  
(e.g.) Bank Overdraft Property No.2  
$
$
$
$
Overdraft
Lender Name & Approved Limit $  
$
Vehicle finance/Loans
Lender Name & Finance Type  
$
$
$
Unsecured loans
Lender Name & Loan Purpose  
$
$
$
Other loans  
Lender Name & Loan Type (e.g. Office Equipment Leases etc)  
$
$
$
Credit card/Store card  
Provider Name & Approved Limit  
$
$
$
Trade debtors (for completion by sole traders only)  
$
Your other liabilities (e.g. liabilities not listed above including contingent liabilities etc)  
$
Total Liabilities $
11f. Does any other person, company or trust have an interest in the assets and liabilities described in the ‘Statement of personal financial position’? (e.g. house owned jointly with spouse and mortgaged in both names)
Yes No
If 'Yes', please list below those assets/liabilities which are subject to the interest of that party and the percentage of that party’s ownership/liability:
Asset/Liability Name of other party Percentage ownership
%
%
%
%
%
%
%
12. Supporting Documentation
Please email/fax/mail the following documentation in support of your application:
  • Copy of your certificate of Business Registration as requested in Section 1
  • Copy of Builder Licence/Registration/Accreditaion as requested in Section 2
  • Copy of evidence of Warranty Eligibility Limit with the most recent Insurer as requested in Section 4
  • Copy of your current approved Elibility Letter, together with a Work in Progress Report as requested in Section 4
  • Evidence of most recent employment for each Director and/or Partner as requested in Section 7
  • Copies of your Certificates as requested in Section 9
  • Copy of the technical letters or references provided to the licensing/registration/accreditation authority in your State as requested in Section 10


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:
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ABN:
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