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Quotation Request for Home Building and Contents Insurance
Please complete this form to request an insurance quote from our firm. Questions marked with an * are mandatory and must be completed so a response can be provided.
If you prefer to provide the information in this form directly over the phone, please indicate this below and we will contact you promptly.
Prior to submitting this form please read the following which describes our practices in relation to the handling and use of personal information.
You have selected:
Home Building and Contents
This information gathering form is appropriate for for owners of a residential property and its contents. The form includes sections to protect your material assets as well as the option to select domestic workers compensation cover. Legal liability is automatically included, the limit of which is defined in the policy selected.
About You
Contact Name:
*
Date of Birth:
(dd/mm/yyyy)
Retired:
Yes
No
Address:
*
(of Property to be insured)
Suburb:
*
State:
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode:
*
Contact Phone No.:
*
Email Address:
*
Tick here if you prefer to provide the information in this form directly over the phone. We will arrange for a representative to contact you promptly.
About Your Home
Type of Building:
House
Unit/Flat
Townhouse
Duplex
Villa
Other
Age of Building:
How is the home occupied?
Owner Occupied
Tenanted
Holiday Home
Unoccupied
Other
Is the home used for Private or Business purposes?
Private Only
Business Only
Combination
Is the home Heritage Listed?
(Tick for Yes)
Construction:
Walls:
Brick
Concrete
Fibro
Mixed
Timber
Other Materials
Not Applicable
Roof:
Concrete
Fibro
Iron
Tile
Slate
Colourbond
Other Materials
Not Applicable
Floor:
Concrete
Mixed
Timber
Other Materials
Not Applicable
Fire Protection:
Sprinklers:
Extinguishers:
Smoke Detectors:
Fire Blankets:
Other:
Security:
Deadlocks on all External Doors:
Bar/Grills on Windows:
Local Alarm:
Back to Base Alarm:
Other:
About Your Insurance Needs
Building Value:
$
Contents Value:
$
Portable Valuables Cover
:
$
Home & Contents Cover Type
:
Select here
Accidental Damage
Defined Events
Is Domestic Workers Compensation cover required?
:
(Tick for Yes)
General
Are your home and contents currently insured?
(Tick for Yes)
If Yes, who is the current insurer?
What is the expiry date of the policy?
(dd/mm/yyyy)
Was the policy arranged by an insurance broker?
(Tick for Yes)
If Yes, name of broker:
Have you made any claims for loss or damage to your home or contents in the past 5 years?
(Tick for Yes)
Comments (if any):
* Indicates a mandatory field.
