Domestic Home & Contents Insurance Quotation

Your details

Your name :

*

Postal Address :

*

State :

*

Postcode :

*

Your Email Address :

*

Your Phone Number :

*

Your Fax Number :

Insured Property Details

Name of Insured :

*

Address to be Insured :

*

Suburb :

*

State :

*

Postcode :

*

Type of Property :

*

Type of Building :

*

How is the home occupied? :

*

Type of cover required :

Accidental Damage

Defined Events

Construction Details

Walls :

*

Roof :

*

Age of building :

*

Property Details

Is the property Heritage Listed? :

No *

Yes

Does the Property have any existing damage? :

No *

Yes

Is the building subject to any current or proposed renovation, reconstruction or demolition? :

No *

Yes

Is the Property situated in a known flood prone area? :

No *

Yes

Please select type of business activity carried out at the Property :

*

Security Details

Are all external doors secured by any combination of the following? Dead Locks - Key Operated Patio Bolts - Steel Screens / Grilles? :

No *

Yes

Are all accessible windows secured by any combination of the following? Dead Locks - Key Operated Patio Bolts - Steel Screens / Grilles? :

No *

Yes

Does the Home have any of the following security measures installed? :

Bars on all Louvre Windows *

Concierge

Fixed Safe

Smoke Detectors

Security intercom

Security gates

Neighbourhood Watch Area

Local Alarm

Back-to-Base Monitored Alarm

None of the above

During the period of insurance, will the building be unoccupied for a period greater than 60 consecutive days? :

No *

Yes

Sums Insured

Building Sum Insured ($) :

*

Contents ($) :

*

Specified Contents ($) (eg. fine art, paintings, antiques and curios and any other bona fide works of art) :

Specified Valuables ($) (eg. articles of jewellery, watches, furs, gold or silver articles) :

*

Previous History

In the last 10 years, have you or anyone else proposing for this insurance been charged or convicted with any criminal offence? :

No *

Yes

In the last 10 years, have you or anyone else proposing for this insurance had insurance declined / cancelled or sinsurance renewal refused by any Insurer? :

No *

Yes

In the last 5 years, have you or anyone else proposing for this insurance made insurance claims against an Insurer under any Home or Landlord Building, Contents Valuable or Liability policy? :

No *

Yes

Total Value of Claims in $ :

Name of your previous Home & Contents or Landlord Insurer :

Additional Comments :