Home Building &/or Contents Insurance Quotation Form

Home Building &/or Contents Insurance Quotation Questionnaire
Thank you for your enquiry regarding Home Building &/or Contents Insurance coverage.

Please complete and submit this questionnaire to enable us to obtain quotes on your behalf.

Please remember that insurance companies rely on the information that you provide to decide whether they will insure you and on what terms/conditions. Before entering into an insurance contract all of the persons and/or entities to be insured have a Duty of Disclosure to supply truthful, complete and accurate information. If you fail to comply with the Duty, the insurer may by entitled to reduce or decline claims.
We are committed to protecting your privacy in accordance with the Privacy Act 1998 (Cth).

We do not sell, trade, or rent your personal information to others.

Please contact us if you would like a copy of our full Privacy Policy to be forwarded to you.

Client Details
Existing client Account Reference (if known)
This can be found at the top right of our invoices, below the Date and Invoice No.
Contact Name *

First Name Last Name
Phone (Home) *
Phone (Work)
Mobile *
E-mail 1 *
E-mail 2

Postal Address *

Street Address / PO Box
Address Line 2
City	State
Post Code	Country

Cover Date
Do you require cover to begin on a particular date? *

Yes No
If yes, please select date: *

Day Month Year Date Picker Icon
Current Insurance
Do you currently have Home Building &/or Contents Insurance? *

Yes No
Please advise why not *
Insurance Company *
Policy Number
Current Expiry Date *

Day Month Year Date Picker Icon
Current Excess on Claims $
Do you currently pay *

Annually Monthly
Current Annual Cost $
Current Monthly Cost $

Interested Parties
Do any other parties hold a financial interest in the property to be insured? (ie mortgage) *

Yes No
Company / Name *

Address

Street Address / PO Box
Address Line 2
City	State
Post Code	Country

Type of Interest *

Property Situation

Address *

Street Address
Street Address Line 2
City	State
Post Code	Country

Building Construction
The walls are *
Please advise mixed construction types *
Please advise other construction type(s) *
The roof is *
Please advise mixed construction types *
Please advise other construction type(s) *
The building is *
Please specify other *
The floors are mainly *
Please specify other *
What year was the building constructed? *
If you do not know the exact year, please enter an approximate year
Has the building been *

re-wired? re-plumbed? neither of the above
What year was the building re-wired? *
If you do not know the exact year, please enter an approximate year
What year was the building re-plumbed? *
If you do not know the exact year, please enter an approximate year

Occupancy
The building will be *
How often will the property be occupied? *

less than 2 nights per month 2 nights per month more than 2 nights per month more than 2 nights per week
Are there permanently occupied residences within 100 metres of the property? *

Yes No
What date did the property become unoccupied? *

Day Month Year Date Picker Icon
What date is the property expected to become occupied again? *

Day Month Year Date Picker Icon
What is the reason for unoccupancy? *
Please specify other *

Other Details
Are you concerned about cover under the policy for any particular item or event that has not already been detailed in this questionnaire? *

Yes No
Please specify *
Would you like to advise us of anything else that you think we may need to be aware of? *

Yes No
Please specify *

Policy Options
Level of Coverage
In most cases we are able to obtain quotes for one of the 3 following coverage types. Where that type is not available in your particular circumstances, our quote will be based on the next level up.

Lowest level: Budget

Also known as: Listed Events Base, Essentials

You're only interested in price, not what's covered under the policy. You want the type of budget policy that you could buy off the internet from any other company, but you still want to deal with a broker.

We don't recommend this cover, as you'll likely be disappointed by the outcome when you make claims.

Mid level: Defined Events

Also known as: Listed Events, Extra, Extra Care, Classic, etc

You don't want budget cover, but you also don't want anything beyond basic standard cover. You don't want to cover Accidental Damage to your building and/or contents (except glass breakage, which is automatically covered). You probably don't have any valuables (jewellery, portable electronics, antiques, art, collections, etc) to cover that are worth more than $1,000 per item (if you do, you can specify them on the policy, however it may be more economical to move up to the next level).

High Level: Accidental Damage

Also known as: Elite, Elite Care, etc

You want the top cover that you can get, with as many included extras as you can get - after all, that's why you use a broker. You want full Accidental Damage cover for your building and/or contents, and you want some automatic cover for valuable items as well.
What level of coverage are you looking for? *

Budget Defined Events Accidental Damage
Excess
Most insurers now have a compulsory basic excess on all claims of between $200 and $350 (some insurers will make you pay an additional excess for claims such as earthquake or flood).

However, you may be able to reduce the premium payable for the policy by taking a voluntary increased excess on claims.
Are you interested in taking an increased excess option? *

Yes No
What is the maximum basic excess that you would be willing to accept? $ *
Flood
In general terms "flood" means the covering of normally dry land by any water (including snow melt):

* escaping or released from the normal borders of:

   - any lake or natural watercourse, whether or not altered or modified, or

   - any reservoir, canal, dam, or stormwater channel, or

* that, because of water that has already escaped or been released, cannot enter:

   - any lake or natural watercourse, or

   - any reservoir, canal, dam or stormwater channel

whether in the immediate region or elsewhere.

Whilst some insurance policies do include flood as standard, most require that you take flood as a policy option if you require the cover.
Do you require a policy that includes flood cover? *

Yes No

Declarations
I am satisfied that the information that I have provided in this questionnaire is accurate and complete.
I understand that the submission of this form is a request for a quotation only. No cover will be in place until such time as you have accepted our quotation in writing, the insurer has agreed to cover you, and you have complied with any of their requirements (ie payment, application form, etc).
Enter the text as it's shown *
Should be Empty:

Home Building &/or Contents Insurance Quotation Questionnaire

Client Details

Cover Date

Current Insurance

Insured Details

History

Interested Parties

Property Situation

Property Type

Building Construction

Occupancy

Security / Protection

Covers and Sums Insured

Other Details

Policy Options

Declarations