What is the address of the property you wish to insure?
Postcode:
Do you owe money on this property?
If Yes , what are the lender's name and address:
What type of building is it?:
Is the building currently occupied?
If No , when will the building be permanently occupied (dd/mm/yyyy)?
What are the walls of your building made of?
What is your roof made of?
Cement
Iron
Slate
Terra Cotta
Tin
Other (please specify in notes below)
(Please select from list)
Age of building:
Year(s)
What is the size of the building?
Squares OR
Square Metres
Does the property have a burglar alarm?
Does the property have key operated window locks?
Does the property have deadlocks and/or security doors fitted?
Age of oldest insured:
Year(s)
Do you want cover for:
a)
Replacement value?
Yes
If Yes , what is the replacement cost of your building?
$
b)
Market value?
Yes
If Yes , what is the market value of your building?
$
Please list any contents items over $20,000 that you want covered:
Total replacement cost of listed items:
$
What is the replacement cost of all other contents?
$
What is the amount of loss of rent (up to 12 months) you want to insure?
$
Do you want cover for Rent Default and Tenant Theft?
Please select the the amount of liability cover required:
$5,000,000 OR
$10,000,000
Is there a swimming pool on the property?
Do you want cover for Workers Compensation for persons employed in
connection with owning, operating and managing the buildings?
1.
Is the building a holiday house, holiday unit or holiday weekender?
If Yes , how often is it visited?
If Yes , how far away is the nearest occupied home?
Metres
2.
Do any parts(s) of the buildings need repairing or replacing?
e.g. gutters, stumping, electrical, pluming, roof.
If Yes , describe repair or replacement work necessary:
3.
Has any insurer refused or canceled cover or required special terms to insure you?
If Yes , please give the insurer's name and the details:
4.
Have any of the applicants suffered any losses or had any claims
made against them within the last 5 years, whether claimed or not?
If Yes , complete the following details:
5.
Do you employ a caretaker?
If Yes , state the estimated annual salary or wages:
$
6.
Do you employ any other persons in connection with the building?
If Yes , state their occupations and estimated annual salary or wages
7.
Do you employ any other persons in connection with any other trade or business?
If Yes , state their occupation(s) / trade(s)
8.
Do you have a Workers' Compensation policy for these trade(s) or business(es)?
If Yes , state the name of the insurance company and policy number