Landlord Insurance Request Form
If you require a quote for a Residential Tenanted Investment property please provide the following in respect to the type of Landlord Insurance you require and we will contact you to complete our detailed analysis of the risk. Once we have issued our documentation to you and completed a risk review we will approach Insurer's on your behalf for terms. The completion or return of this form is not a confirmation or request for cover it is a means of contact to commence our review of your requirements. If you have an IMMEDIATE cover requirement please phone our office on 99297155 9-5pm weekdays. We welcome the opportunity to provide a quotation. Click for Location Map and Directions

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IMPORTANT:Please read Our Financial Services Guide before you proceed.

IMPORTANT:Please read YOUR DUTY OF DISCLOSURE What you must tell the insurer.

Insured Name


Effective date cover is required:

Details of property to be insured:

Located in (Number/Street)
Located in (Suburb/Town)
Located in (State)
Located in (Postcode)
Is the property part of a registered strata plan? Yes No
Is the property Professional Managed? Yes No
Is the property Heritage listed? Yes No
Does it meet relevant cyclone standards? Yes No
Does the property have a Pool and/or Spa for which you are liable? Yes No
Does the property have a Jetty and/or Pontoon for which you are liable? Yes No
Does the property have a Tennis Court for which you are liable? Yes No
No part of the property will be used for earning income other than residential rental income? Yes No
Do you have a formal rental agreement with your tenant/s? Yes No
The property is rented on the basis of a long term rental agreement minimum 3 mths? Yes No
Is the Property well maintained and structurally sound and secured against wind and rain? Yes No
Does it have reticulated water? (city/town supply) Yes No
Approx. year built
Approx. year renovated /rewired/replumbed
What is the construction of the dwelling? (external walls)
What is the roof of the dwelling? (material)
Type of Dwelling?
How is the property occupied?
What is the weekly rent? $ (Type 'Nil' if not applicable)

Amounts to be insured:

The home (building) $
Preferred building policy excess
The contents  $
Preferred contents policy excess
Additional Covers (Policy Options) Optional extensions to your landlord's insurance policy
Loss of rent 12months

Do you require Rent Default/Theft by a tenant? (requires rental agreement) Yes No

Security details:

Do all external windows have  ... standard locks? ... or         key locks?
Do all external windows have  ... security screens, bars, grills or aluminium rollover shutters? ...         Yes No
Are all external doors fitted with

Double-key deadlocks

Single-key deadlocks or security doors

Standard locks

Do all external sliding doors have ... Patio bolts and/or security doors?

Standard locks only?

There are no external sliding doors

What burglar alarm/s are installed? Monitored alarm system

Audible local alarm

No alarm system

Please make any other comments you think relevant regarding home security.

Details of insured party/ies:

Name 1. 2.
Birth date 1. 2.
Retired Yes No Yes No
Pensioner Yes No Yes No

Your claims history:

How many years since you have made a claim on a home, contents or special risks insurance policy? (Type 'N/A' if not applicable)
How many claims in last 5 years? (Type 'Nil' if not applicable)
Please list any claims in the last 5 years including brief detail, amount claimed and approximate date of claim

Other Important Information:

What is the name of your current insurer for this property? (Type 'N/A' if not applicable)
What is your mortgage provider/s name 1st 2nd
Any other information you wish to disclose about this risk?
Any Insurer declined to insure or placed special terms on any of your policies? Yes No
Have you been declared bankrupt or placed into receivership or liquidation? Yes No
Have you received any threats to life or property? Yes No
Have you been convicted of any crime in the last 10 years Yes No

IMPORTANT: Please Read our General Advice Warning