1a.
List the names of all Registered Owners (and/or all Directors if the Owner or Owner Builder is a company or
corporate trustee) of the subject property:
*Please attach copies of all drivers licences - Please see Question 6
1b.
Name of the Owner Builder on the Building Permit or Certificate of Consent:
ABN (if applicable):
Owner Builder permit/certificate of consent no.:
Current residential address:
Postcode:
Current postal address (if different to the above residential address):
Postcode:
Forwarding postal address after settlement (if different to the above residential address):
Postcode:
2a.
Full site address (provide details where applicable eg. unit no., lot no. or street no. & name, suburb/town, postcode):
2b.
Shire/Council:
2c.
Is there more than one dwelling on the subject property?
If "Yes" , please provide:
3a.
Type of Works:
3b.
Please provide a brief description of the residential/domestic building works to be insured:
3c.
What was the total cost of residential/domestic building work to be insured?
$
3d.
If a refurbishment or addition, what is the total cost of the non-structural residential/domestic building works?
$
3e.
What was the construction completion date?
3f.
What was the date of occupancy by the Owner Builder?
3g.
Has a Contract of Sale been signed?
If "No" , proceed to Section 4. If "Yes" , please continue with section 3.
3h.
Please provide the date the contract was signed:
3i.
Anticipated settlement date:
3j.
Is there any relationship between the Owner Builder and the purchaser? (i.e. family members, business relationship etc)
If "Yes" , please provide details
4a.
5a.
Have any of the Owner Builder/s ever held a builders/contractors license/registration?
5b.
Have any of the Owner Builder/s ever taken out Home Warranty Insurance previously?
5c.
Have any of the Owner Builder/s ever had a Home Warranty Insurance claim lodged against them?
5d.
Have any of the Owner Builder/s ever been declared bankrupt or been a director, partner, proprietor,
shareholder or manager of a business placed in external administration, a scheme of arrangement,
receivership, liquidation or provisional liquidation?
5e.
Have any of the Owner Builder/s ever had an application for Home Warranty Insurance rejected or declined?
If you have answered "Yes" , to any of the above please provide full details
6.
Supporting Documentation
Please email /fax/mail the following
documentation in support of your application:
Copies of drivers licences of owner builders listed in Section 1
Copy of the most recent Rates Notice for the property Section 2