Email General Questions Building Details Cover Details Contact Person Insured Name Mailing Address Date of Birth Have you had any claims in the last 5 years? Yes No Have you ever had insurance declined or special conditions imposed? Yes No Have you ever been convicted of a crime or declared bankrupt? Yes No General Questions Building Details Cover Details Type of building Residential House Flat or Unit Townhouse, Villa, Duplex Caravan Home Construction of external walls Brick Veneer Concrete / Iron / Steel Solid Brick Timber / Wood Weatherboard Fibro Construction of Floor Construction of roof Tile Slate Metal Cement Sheet Wood How is the home occupied? Owner Occupier Rented Family Member Holiday Home Building size in square metres (if known) In what year was home built? Has it been rewired in the last 40 years? Yes No General Questions Building Details Cover Details Building Replacement Cost Contents Replacement Cost: NB: This includes carpets, curtains etc Loss of rent per week Rental Default Yes No Workers Compensation Cover Yes No Will any part of the property be used for earning income other than rental income? Yes No Security Options Local alarm Back to base alarm Deadlocks on all doors Keylocks on all windows Additional Info Send a copy to email address
