On-line Landlords Residential Property Insurance

Thank you for considering our on-line landlords residential property 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 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.

About the property you wish to insure:
What is the address of the property you wish to insure?
Do you owe money on this property?
Yes No
If Yes, what are the lender's name and address:
What type of building is it?:
Private house Unit or flat
Other please specify:
Is the building currently occupied?
Yes No
If No, when will the building be permanently occupied (dd/mm/yyyy)?
What are the walls of your building made of?
Brick Wood Fibro
Other please specify:
What is your roof made of?
Age of building: Year(s)
What is the size of the building?  Squares  OR   Square Metres
Does the property have a burglar alarm?
Yes No
Does the property have key operated window locks?
Yes No
Does the property have deadlocks and/or security doors fitted?
Yes No
Age of oldest insured: Year(s)
About the value of insurance you are seeking:
Building details:
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? $
Contents details:
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? $
Loss of rent:
What is the amount of loss of rent (up to 12 months) you want to insure? $
Rent Default and Tenant Theft:
Do you want cover for Rent Default and Tenant Theft?
Yes No
Please select the the amount of liability cover required:  $5,000,000  OR    $10,000,000
Is there a swimming pool on the property?
Yes No
Workers' Compensation (Available in NT, WA and Tas. only)
Do you want cover for Workers’ Compensation for persons employed in connection with owning, operating and managing the buildings?
Yes No
1. Is the building a holiday house, holiday unit or holiday weekender?
Yes No
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.
Yes No
If Yes, describe repair or replacement work necessary:
3. Has any insurer refused or canceled cover or required special terms to insure you?
Yes No
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?
Yes No
If Yes, complete the following details:  
Type of loss or claim Date Amount Name of insurer (if applicable)
Answer questions 5 to 8 only if Worker's Compensation is required
5. Do you employ a caretaker?
Yes No
If Yes, state the estimated annual salary or wages: $
6. Do you employ any other persons in connection with the building?
Yes No
If Yes, state their occupations and estimated annual salary or wages
Occupation     Estimated Annual Salary or Wages
7. Do you employ any other persons in connection with any other trade or business?
Yes No
If Yes, state their occupation(s) / trade(s)
8. Do you have a Workers' Compensation policy for these trade(s) or business(es)?
Yes No
If Yes, state the name of the insurance company and policy number

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:
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:
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss quote details in person. Please leave a contact phone number and best time to call to facilitate this.
Your full name:
Company/Business/Name of Applicant to be Insured:
Your phone number (please include area code):
Your mobile phone number:
Best time(s) to call:
Please send my quote by (select at least one):
email phone fax mail
Your email address:
Your website address:
Your fax number:
Your postal address: