On-line Home Warranty Insurance for Owner Builder

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 - Owner Builder Information
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:
Full name *Driver‘s licence no. and state Date of birth
*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:
Section 2 - Property address (please attach a copy of the most recent Rates Notice - see Question 6)
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?
Yes No
If "Yes", please provide:
Unit No.(s) No. of Units
Section 3 - Construction information
3a. Type of Works:
Non-Structural Renovation
Structural Renovation
Other - Details
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?
Yes No
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)
Yes No
If "Yes", please provide details
Section 4 - Certification (copies of relevant certificates to be made available at time of inspection)
  Name Telephone No. Address Postcode
Local Certifying Authority or Private Certifier      
Geotechnical Engineer
Section 5 - Owner Builder Background (including all registered property owners of the subject property)
5a. Have any of the Owner Builder/s ever held a builders/contractors license/registration?
Yes No
5b. Have any of the Owner Builder/s ever taken out Home Warranty Insurance previously?
Yes No
5c. Have any of the Owner Builder/s ever had a Home Warranty Insurance claim lodged against them?
Yes No
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?
Yes No
5e. Have any of the Owner Builder/s ever had an application for Home Warranty Insurance rejected or declined?
Yes No
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

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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