On-line Home Warranty Insurance 'Eligibility' Application For Building Entities Owned By A Publicly Listed Company In Australia

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. Trading name(s) (copy of the Certificate of Business Registration must be provided - Please see Question 12):
1b. Is the builder a subsidiary of another entity?
Yes No
If Yes, please provide details of your business structure:
1c. ACN:
1d. Trade Association membership(s)?
H.I.A M.B.A Other - Please specify
1e. Membership No’s?
1f. States/Territories of operation:
1g. State in which Eligibility is being sought:
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:
2j. Please provide a list of all Construction Manager/Qualified Supervisors associated with your business:
Name Licence/Registration/Accreditation No(s) Experience (years) Date of Birth
Section 3 - Financial information required - Please see Question 12
To enable assessment of your application, we require the following financial information prepared in accordance with the Coporations Act 2001:
  • Full and final audited 'Annual Financial Report' for the last three (3) financial years being:-
    • the financial statements for the Applicant;
    • the consolidated financial statements for the economic entity;
    • the directors' report;
    • the auditors' report;
    • copy of the latest Annual Report of the Applicant company.
  • Should the above 'Capital Annual Financial Report' be more than nine (9) months old, we would require, in addition to the above, half-yearly financial report.
'Economic entity' for the purposes of GNG HWI applications and assessments means "a group of entities comprising the parent entity for each of its subsidiaries".
A related entity for the purposes of GNG HWI applications and assessments is as defined in Section 9 of the Coporations Act 2001 (Cth).
Section 4 - Input tax credits
4. Do you intend to claim 100% of your input tax credit entitlement for the GST applicable to future policy premiums?
Yes No
If No, please advise what percentage you intend to claim: %
Section 5 - Business and personal background information
5a. Has any director of your business ever been a director of a business placed in external administration, a scheme of arrangement, receivership, liquidation or provisional liquidation?
Yes No
5b. Has any director 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
5c. Do the directors know of or have any information of a 'material' nature (i.e. important, significant, relevant) not disclosed in the attached financial statements 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 financial statements/information provided.
Yes No
5d. Has your business held or is currently holding Home Warranty Insurance eligibility? If yes, please provide a copy of the documentation confirming your prior or current approved 'Eligibility limit', together with a current Work in Progress Summary. The Work in Progress Summary needs to provide totals to all current contracts insured by your current insurer including: total contract values insured, number of contracts insured and number of contracts insured where work has not commenced at site.
Yes No
5e. Has a prior home warranty insurer ever paid a claim in repsect of your business and/or is any director of your business aware of any circumstances that may give rise to a claim (e.g. any notification of a claim from you current or prior Home Warranty Insurer)?
Yes No
5f. Is any director or manager of your business aware of any material Court, Tribunal or arbitration hearing involving or in any way related to residential home building work undertaken by your business?
Yes No
5g. Has any director of your business ever been a director, partner, proprietor, 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’; or
  • had their Job Specific ‘Eligibility’ withdrawn.
Yes No
5h. Has your business or any related entity contained within the economic entity given any form of security to another Home Warranty Insurer (eg. 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
Please provide a detailed explanation to any questions answered 'Yes' to Queation 5a to 5h above:
Section 6 - Construction turnover
6. Please complete this table by providing an estimate of construction revenue/activity by project category/construction segment type
Project Categories Last financial year Previous finanical year
  30/6/ 30/6/
Residential Construction % %
Commercial Construction % %
Civil Construction % %
Other Construction (please provide details)
% %
Total Business Turnover 100% 100%
Section 7 - Average construction cycle
7a. Construction Lead-Time (i.e. period from contract signing/deposit taken until starting on site): weeks
7b. Construction Phase (i.e. period at site until handover to homeowner): weeks
Section 8 - Recent Contract History
8. Please provide a summary listing of the completed construction projects undertaken by the Applicant in the past 2 years including the type of construction (i.e. commercial, civil, residential low-rise, residential high-rise etc):
Section 9 - Trade Credit references
9. Please list the details of your 3 largest building material suppliers (from the last 12 months) who will confirm your credit payment history.
Supplier Name Amount Limit Payment Terms Facsimile no.
$ days
$ days
$ days
Section 10 - Forecast Building Activity - for the next 12 months
10a. Amount of 'Maxmimum Insurable Turnover' being requested for the next 12 months: $
  Total estimated construction  
Type of Construction No. of jobs $ Estimated maximum contract value
Single Dwelling - New Contract Home/Houses $ $
Speculative Dwellings (refer to 'definitions' below) - Houses or Units $ $
Unit/Duplex - Project/job value does not exceed $1.5M in total and/or consists of 6 or fewer dwellings on the one site $ $
Multi-Dwelling - Project/job value exceeds $1.5M in total and/or consists of more than 6 dwellings on the one site $ $
Dwelling Improvements (structural) $ $
Dwelling Improvements (non-structural) $ $
Swimming Pools $ $
Kit Homes $ $
Multi-Storey (refer 'definitions' below) $ $
Project Management $ $
Other building work, including commercial projects and subcontracting $ $
One project of 5 units is to be classified as '5 jobs', one project of 10 units is to be classified as '10 jobs'.
Contract price is to be GST inclusive
Multi-Storey: A project where there is a rise of more than 3 storeys and contains two or more separate dwellings. A storey does not include a space within a building if the space includes accommodation only intended for vehicles
Speculative Dwellings: A project where the Contractor/Builder who owns land carries out Residential Building Works on it.
Section 11 - Non-Structural Turnover for the next 12 months
This section is to be completed by Applicants who require HWI for Non-Structural improvements only
11a. Total estimated insurable non-structural construction for the next 12 months (contracts $12,000 and above) $
11b. Total estimated non-insurable non-structural construction for the next 12 months (contracts below $12,000) $
11c. Estimated largest non-structural contract for the next 12 months $
Note: Contract price is to be GST inclusive.
Section 12 - Required Documents
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 your Financial information as requested in Section 3

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.
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