TGN Home insurance quote form

INSTRUCTIONS

TGN Advisers are proud to partner with Vero in providing our clients with a market leading home, contents and vehicle policy. Having experienced the Christchurch Earthquakes first hand, our perspective of the importance of a solid and reputable insurer standing behind our clients at their time of need is our top priority. It is all about what happens at Claim time.

Please fill in a separate form for each property. This form is best filled in on a touch screen device such as a phone or tablet, as you can then sign on the screen and submit direct to us. NOTE - When signing there is a 'clear' button so that you can practice until you are happy with the result.

If you would like to be guided through this form on a video call (sharing your screen) by a member of our team please make a time by clicking here - usually we have availability within 15 minutes or call 0800 51 00 44 or email admin@tgn.co.nz if you require any assistance.

Please also complete our 'Working with TGN Advisers', we provide this to ensure you understand how we work together, it is also a legal requirement. Click here

Who owns the property?*

Individual/sTrustCompany

Is the home on a lifestyle block or farm?*

If 'Yes' please call George on 029 43 67 432 to discuss your options

Customer Name (eldest policy holder)

First NameLast Name

Name the policy is to be held under - this needs to note all interested parties if their is a mortgage interest on the property eg. Frank and Chris Smith

Name of Trust

Names of Trustees

Date of Birth of the eldest Trustee

Date

Name of the Company

Name of the eldest Director

Date of birth of the eldest Director

Date

Date of birth

Date you'd like cover to start - if you don't know please put todays date*

Date

Home Phone Number

Area CodePhone Number

Mobile Phone Number

Area CodePhone Number

Email Address*

example@example.com

Secondary Email

example@example.com

Address of property to be insured*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Customer home or business address - if different from insured address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Have any house (excluding contents) related claims within the last 12 months?*

Please provide details of any claims made within the last 12 months

How many self-contained units are at this location?

Home onlyHome plus units

How many units?

Would any of the units cost less than $150,000 to rebuild?

YesNo

You are unable to proceed with placing this risk on-line. Please phone us for further instructions.

What is the 'Sum Insured' of your home - THIS IS IMPORTANT - a professional valuation is strongly advised - please read the information below -*

The reason a 'Sum Insured' valuation is important for your largest asset -

TGN recommend using a professional valuer at least initially as it is vital to demonstrate 'due diligence in the estimation of the sum insured' for your house. Following a natural disaster the requirement to use 'Sum Insured' rather than 'Total Replacement' puts a lot of responsibility upon the property owner - the majority of property owners will most likely be under insured. There are factors such as demolition costs, disposal, construction inflation (particularly after a natural disaster), consent and professional fees which when added together mean that rebuilding a house will be in most cases be more expensive than expected. TGN does not provide advice on values for 'Sums Insured', this is the responsibility of the property owner. In order to help clients feel comfortable with their level of cover we have negotiated a special rate with valuers in the main centres starting at $550 + gst for a full valuation of your home - we highly recommend taking up this offer even if you only do this to establish a baseline valuation to start with which we can then apply construction inflation against each year thereafter. To have peace of mind that your biggest asset is adequately insured, please get a professional valuation done.

Please ask my local valuer to contact me to arrange a valuation of my property for 'Sum Insured' purposes*

By asking for your local valuer to contact you, you are granting permission for your local valuer to keep TGN informed throughout the valuation process unless otherwise advised, this is in order to allow us to make the process as efficient for you as possible. You are also granting TGN and your local valuer permission to share the information contained in this form.

The alternative is the Cordell Calculator, which is free to use but in our experience does not provide a valuation reliable enough for such an important asset as your home or investment properties. However, if you have indicated above "No, thankyou I'm comfortable using the online Cordell Calculator" then please click on the link below put in your address, complete the form to the best of your knowledge. It will give you the option to download and email the valuation at the end, please email to admin@tgn.co.nz and download for your records. Please insert the valuation amount once you are happy with it for rebuilding your house, we recommend adding 10% as well for the reasons outlined previously. Here is the link - https://sumsure.corelogic.co.nz/#/products/8/profiles/219

What is the main type of home?*

How is the house used the majority of the time?*

Select 'Unoccupied' if this home is currently vacant or will soon become vacant (and the vacancy has exceeded or will exceed a period of 60 days)

IMPORTANT if a rental / investment property - Landlord's Extension

As the property is a rental or partially rented (ie. a holiday home, partially tenanted) then you have the option of adding Landlord's cover. By selecting 'Standard Cover' option below, the additional protection provided by the Landlord's Extension will not apply to this tenanted home. By selecting the 'Standard Cover with Landlord's Extension' option, the tenanted home will be provided with additional cover for:

Furnishings owned by the landlord (limited to only: dishwashers, stoves, refrigerators, washing machines, dryers, and built in microwaves), for clarity fixed floor coverings such as fitted carpets, drapes, curtains and blinds are part of the House insurance ; and
Loss of rent if the home is uninhabitable due to loss or damage covered by this policy; and
- Where you have selected the 'Maxi Cover' option (which is default for our clients), the Landlord's Extension will also provide cover for Malicious damage or theft by tenants; and
- Loss of rent due to non-payment by tenants.

Limits and Conditions apply to this extension of cover, please refer to the 'Policy Wording' for full details, scroll to the end of the form and double click to download the policy.

Please indicate your preference, for investment properties 'Standard Cover with Landlord Extension' is recommended, otherwise 'Standard Cover' -*

Standard CoverStandard Cover with Landlord Extension

If 'Other' - how is the home used?

Is this home part of a body corporate?*

YesNo

WARNING -

You may be doubling up on insurance that should already be in place via your Body Corporate. Please seek advice from your Body Corporate or legal advice before continuing.

Does this home have a monitored smoke or heat detector?

YesNoOther

What is the approximate size of the home in Square Metres?

What year was this home built - you can find this in the Cordell Calculator*

Has this home been fully re-wired since 1945?

YesNo

Does this home have scrim walls?

YesNo

Has the Historic Places Trust placed any restrictions or preservation orders on this home?

YesNo

Are there any entries against the certificate of title for this home and noted within LIM?

YesNo

Is any form of business run from this home?

YesNo

What type of business?

Is there a mortgage on this home? If so, which bank and how many mortgages?

What excess option would you like? The higher the excess the lower the premium will be, but you will have to fund this first amount yourself in the event of a claim. If there is a small claim of less than the excess then there will be no benefit paid.

Premium Instalments - a service fee is charged for premiums paid by instalments other than annually. For premiums between $2-20k these are 7% for fortnightly and monthly, 5% quarterly, 3.5% 6 monthly, 0% annually.

Would you like to pay by Direct Debit

If 'No' an invoice for the 12 months will be generated and sent to you to be paid on receipt

Paperless Direct Debit

If 'No' and you'd prefer to use a paper Direct Debit form please scroll to the bottom of this page, download the direct debit form, fill it out and scan, photograph it back to admin@tgn.co.nz or post it to TGN Advisers, PO Box 79008, Christchurch 8046

Do you have sole signing authority on the nominated account?

The customer must have sole signing authority on the account to authorise a paperless direct debit. ie. If more than one signature is required as an authority to operate the account a Paperless Direct Debit cannot be issued.

Conditions of instruction to accept paperless direct debits
You may cancel the Instructions at any time by giving written notice of termination to us at Vero Insurance.

Should you dispute any direct debit initiated upon your nominated account within 9 months of the first Direct Debit, then Vero as the Initiator must produce evidence of your Instructions and Confirmation within ten business days. Should Vero fail to do so, then your bank may reverse the Direct Debit(s).

Should you not be satisfied that the Instructions you have given authorise Vero to Direct Debit your nominated account, your bank may reverse the Direct Debit(s). If the disputed transaction is outside of the 9 month period then the dispute will be resolved between you as the Acceptor and Vero (unless the transaction is the result of forgery, fraud or error).

I agree to the paperless direct debit terms and conditions

YesNo

Account type?

Enter the name of the person authorised to operate the account as per mandate.

Card Type

VISAMastercardAMEX

Credit Card Number

Card Name

Card expiry date mm/yy

Bank Account Number

Account name

Has your House sustained any earthquake damage?*

If 'Yes' please complete questions below, and download, sign and photograph / scan the Vero Supplementary Damage form from the end of this form back to admin@tgn.co.nz .If 'No' move down to the Declaration Questions at the bottom of the form

Technical Category (TC) of Land on which this property is situated - Canterbury properties

Find the Category here https://mylandzone.canterburymaps.govt.nz/#/

When did you, or when do you intend to, purchase this property?

DayMonthYear

Who did you purchase the property from?

Was the Home built after the February 2011 Earthquake?

Did the Home/Land suffer ANY Earthquake damage between September 2010 and February 2011?

If you answered 'Yes', please attach a copy of the Scope of Works and Practical Completion Certificate detailing the repair to the Home/Land if you do not have this to hand, this can be sourced from EQC by visiting the following web page - https://www.eqc.govt.nz/contact-us/official-information-act-request-form/ And/or the insurer at the time of damage. If you answered 'No', please go to the last question in the form.

Please detail the damage that occurred at this property (to the Home and/or to the Land). If the Home suffered damage to the foundation, you must specifically detail the extent of the damage.

Is there any unrepaired damage to the Home and/or other structural improvements to the Land? If you answer 'Yes' to this Question, please attach a copy of the Scope of Works detailing the repairs required to the Home/Land. This can be sourced from EQC https://www.eqc.govt.nz/contact-us/official-information-act-request-form/and/or the insurer at the time of damage. If you answered 'No' to Question 8, please go to Question 'Has the Insurer commenced repair work?' below

YesNo

Who was the insurer (other than the EQC) between September 2010 and February 2011?

What was the policy number - if known?

Has the EQC and/or the Insurer accepted a claim for the damage?

Have repairs been completed?

Are any of the repairs (completed or otherwise) defective?

By defective we mean have any repairs failed or required EQC or the previous insurer to re-visit the property to re-assess completed repairs orpreviously undiscovered damage. If you have answered yes, which repairs have been classed as defective? Please email details of defective repairs to admin@tgn.co.nz

MonthDayYear

Has the Owner (past or present) registerd for the EQC "On-sold Over-cap Programme" Yes/No

If you have answered yes to the previous question, have you discussed or agreed with the Owner whether you will receive any funds from the cash settlement? Yes/No

Who carried out the repairs? Please tick

EQCInsurerProperty OwnerOther

Is there any unrepaired damage to the Home and/or to the Land?

If yes, please confirm details of any unrepaired Home and/or Land damage in the space provided below.

Has the Owner (past or present) received or requested a cash settlement from the EQC or the Insurer?

Has the Owner (past or present) carried out or organised to carry out any of the repairs to the Home/Land themselves?

If you have purchased the Home (that existed at the time of the Earthquake events), have you discussed or agreed with the previous Owner that you will receive any funds from any insurance claim made by the previous Owner?

If you have answered yes to the previous question, have you discussed or agreed with the Owner whether you will receive any funds from the cash settlement? If you have a written agreement, please send a copy to admin@tgn.co.nz

Declaration Questions

Have you or any members of your family, or any other person or entity to be covered by this insurance: 1. In the past 2 years had more than 2 losses; or in the past 2 years made claims totalling more than $2,500?*

YesNo

Please provide details

2. Ever: Been aware of any damage from flooding, landslip, or earthquake at any address relating to this policy; or, Had any insurance declined, cancelled, renewal refused, terms or conditions imposed or claim declined; or, Been engaged in any criminal activity or had any criminal convictions, acquittals or have any criminal prosecutions pending? (The information sought by this question is subject to the rights set out in the Criminal Records (Clean Slate) Act 2004.)*

YesNo

Please provide details

In order to proceed with this insurance cover application you will need to provide confirmation of the following authorisation and declaration statements :

Authorisation and Privacy Statement

1. You authorise TGN to give to and obtain from other Insurance Companies, Insurance Brokers, the Insurance Claims Register Ltd or any other party any information relating to this or any other insurance held or previously held by you, and any claim(s) made by you, and any information you have provided now or previously for the purpose of payment
2. TGN has collected your personal information in order to evaluate your insurance requirements for the purpose of allowing a selection of insurance companies to decide whether to issue insurance cover and, if so, on what terms. Failure to provide any personal information requested may result in your application for insurance being declined.
3. TGN has also collected your personal information in order to monitor and service your ongoing general insurance requirements, conduct market research, data processing and statistical analysis. Unless you notify TGN that you disagree, the information you supply may also be used by TGN to provide you with information about other facilities, products and services.

Have you read and understood the authorisation statements ?*

YesNo

4. Your personal information is held by TGN. In accordance with the Privacy Act 2020, individuals have a right to request access to and correction of their personal information (a fee may be payable) by contacting TGN Investments Limited at admin@tgn.co.nz
5. TGN will provide information on the insurer financial strength rating prior to any policy issuance.

Declaration

I/We declare that the information I/we have provided to TGN and any subsequent Insurer within this proposal, application or declaration form is in every respect complete and correct, whether received or provided verbally, electronically or printed and in relation to this property shall be the basis of the contract between me/us and the Insurer, and I am/ we are willing to accept cover subject to the Insurer's policy conditions and any special terms they may require.

I/We authorise TGN or the subsequent Insurer to give and obtain from other Insurance Companies, Insurance Brokers, the Insurance Claims Register Limited or any other party any information relating to this or any other insurance held or previously held by me/us and any claim made by me/us.

You declare that subject to any rights you have under the Crimincal Records (Clean Slate) Act 2004, the information given is in every respect correct and complete and all material information has been disclosed to us.

Have you read and understood the declaration statement?*

YesNo

Applicant Full Name*

First NameMiddle NamesLast Name

Applicant Signature

Date*

DayMonthYear

Next you will be taken to the contents quote form - thank you

If you would like to read the Policy document please click on the pdf below -

If your property was damaged in an Earthquake please click on the pdf below to download it, print, fill out and scan / photograph back to admin@tgn.co.nz or post to TGN Advisers, PO Box 79008, Christchurch 8446

To set up a Direct Debit using a paper form please click on the pdf below to download it, print, fill out and scan / photograph back to admin@tgn.co.nz or post to TGN Advisers, PO Box 79008, Christchurch 8446

House / Contents / Car Application Form - If you'd prefer to fill in a paper version of the application form please click on the form below to download it, complete it and either scan / photography back to admin@tgn.co.nz or post to TGN Advisers, PO Box 79008, Christchurch 8446