Landlords Residential Quote Form
Insured Name
*
Contact name
*
Email
*
Retype email
*
Telephone Number:
Risk Address of Property to be insured
*
State
Please Select
NSW
QLD
VIC
WA
SA
NT
TAS
Post Code
*
Prefer Monthly or Annual payments
Please Select
Annual
Monthly
Please provide some details about the property as this is required to calculate your insurance premiums
Building Construction Walls
*
Please Select
Double Brick
Brick Veneer
Besa Block
Tilt Slab
Fibro
Timber
Steel
Colourbond
Other (please provide more info)
Mixed (please provide more info)
Buildings Frame
*
Please Select
Brick
Besa Block
Tilt Slab
Timber
Steel
Other (please provide more info)
Mixed (please provide more info)
Buildings Roof
*
Please Select
Tile
Iron
Concrete
Timber
Abestos
Colourbond
Fibro
Other (please provide more info)
Mixed (please provide more info)
Buildings Floor/s
*
Please Select
Concrete
Timber
Tiled
Other (please provide more info)
Mixed (please provide more info)
Approximate year Built
*
Is Home on more than 5 Acres or 2HA
*
Please Select
YES
NO
Home elevated number of levels
*
Please Select
Single Storey
Single storey Raised more than 1200mm
Double Storey
Three or more stories
Has home ever been flooded or unindated with water more than once in last 10years
*
Please Select
YES
NO
Do you want flood cover
*
Please Select
YES
NO
Security Protection
Deadlocks all external doors
Key Operated window locks all windows
Bars or grills all windows
Local alarm
Back to base monitored alarm
Normal key locks
No Security
Occupancy Type
*
Please Select
YES - Permanent tenants
YES - Holiday rented
YES - More than 2 unrelated persons rent property
NO - Unoccupied Dwelling
Property managed by real estate/property manager
Please Select
YES
NO
Please provide some details of Sums insured or Cover required as this is required to calculate your insurance premiums
BUILDING SUM INSURED
CONTENTS SUM INSURED
LIABILITY
Please Select
$5,000,000
$10,000,000
$20,000,000
LOSS OF RENT COVER (ANNUAL)
OPTIONAL: Rent default & Theft by tenant cover required
Please Select
YES
NO
HISTORY DETAILS ( if you answer yes to any of the below questions please provide further information in free text box below)
Has the insured or any Directors had any claims in the last 5 years
*
Please Select
YES
NO
Has the insured or any Directors had any criminal convictions in the last 10 years
*
Please Select
YES
NO
Is the insured or any Directors aware of any circumstance that may lead to a claim
*
Please Select
YES
NO
Has the insured or any Directors had a claim refused, insurance declined or any special conditions imposed in the last 5 years
*
Please Select
YES
NO
CURRENT INSURER
Expiry Date of current Insurance or date to start cover
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
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2015
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Year
ANY OTHER INFORMATION PLEASE USE THIS TEXT BOX
ANY OTHER INSURANCE YOU WANT QUOTES ON SUCH AS BUSINESS,MOTOR, LANDLORDS, WORKERS COMPENSATION PLEASE USE THIS TEXT BOX
DUTY OF DISCLOSURE ( Please ensure all details are correct as answers on this form will be used to obtain quote and or cover and if incorrect or not disclosed information this could affect a claim being paid)
Submit
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