Details of property to be insured: Located in (Number/Street) Located in (Suburb/Town) Located in (State) --- Select --- NSW Vic Qld WA SA Tas ACT NT 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) --- Select --- Brick and/or Concrete Brick and Timber Timber Fibro Other What is the roof of the dwelling? (material) --- Select --- Tile Concrete Shale Fibro Cliplock Type of Dwelling? --- Select --- House Unit Townhouse Terrace Semi How is the property occupied? --- Select --- Tenant/Lease Tenant/No Lease Weekender/holiday home Currently unoccupied What is the weekly rent? $ (Type 'Nil' if not applicable)
Amounts to be insured: The home (building) $ Preferred building policy excess Standard $100 $250 $500 $750 $1,000 The contents $ Preferred contents policy excess Standard $100 $250 $500 $750 $1,000 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