Home & Contents Insurance

1
Let us know a little bit about you* This field is required.
Name
Please enter your email
Please enter your phone
Oldest Insured Date of Birth
2
Tell us a little bit about your home
Address of Property to be Insured
Brick Veneer
Double Brick
Timber Weatherboard
Concrete
Mudbrick
Fibro
Steel
Other (Please type Construction below)
Wall Construction
Please Select
Please Select
1
2
3
4
other
Number of Levels
Please Select
Please Select
Yes
No
Is the house on more than 5 acres
Please Select
Please Select
Colourbond
Tile
Iron
Concrete
Fibro
Other (Please provide below)
Roof Construction
Year Built
Any other information e.g Interested Party such as Bank or Building Society
3
Property Over 5 AcresYou have indicated your house is on more than 5 acres as such there are a few more questions
How many acres is your property?
Beef Cattle
Dairy Cattle
Sheep
Goats
Horses
Hobby Farm
Mixed (Please explain in further information below)
Do you have any livestock on the property e.g Sheep, Cattle & Goats etc
Any Further information or cover required
4
What would you like the following insured for
Building Sum Insured
Contents Sum Insured
Unspecified Valuable limit
Please list any items of significant value you would like insured seperate
5
Flood & Security* This field is required.
Please Select
Please Select
Yes
No
Do you require flood cover. Please note flood cover is unavailable for properties over 5 acres
Deadlocks on ALL external doors
Key operated window locks all windows
Bars or Grills all windows
Local alarm
Back to base alarm
No Security
Security
6
Duty of Disclosure * This field is required.
Please Select
Please Select
Yes
No
Has the insured had any claims in the last 5 years
Please Select
Please Select
Yes
No
Has the insured had any criminal convictions in the last 10 years
Please Select
Please Select
Yes
No
Has the insured had a claim refused, insurance declined or any special conditions imposed in the last 5 years
Please Select
Please Select
Yes
No
Is the insured or any Directors aware of anything that may lead to a claim
7
Date you need this Insurance to start?* This field is required.
Date
Day
Month
Year
8
Tags
Todo
In Progress
Done
Should be Empty: