HOME & CONTENTS FACT FIND
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Insured Details
Insured Person(s)
*
Full Name(s) of all persons insured
Date Of Birth
*
Date of birth of all insured people
Previous Claims
*
Yes
No
If Yes, please give Details
Provide any information regarding previous claims.
Criminal Convictions?
*
Yes
No
If Yes, Please give details
Provide information regarding any criminal convictions.
Are you currently insured?
*
Yes
No
If Yes, Please provide the name of insurer, and your due date?
*
Please advise your current premium
*
$$
Please advise your requested excess
*
$$
Have you ever been declared bankrupt?
*
Yes
No
Your Best Contact Number
*
Format: (000) 000-0000.
Your Best Email
*
example@example.com
Property Details
Insured Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Policy Dates:
Policy Start & Finish Dates
Property Type:
*
House
Unit
Townhouse
Duplex
Walls Materials
*
Brick
Brick Veneer
W/Board
Hardiplank
Concrete
Other
Roofing Type
*
Iron
Cement Tile
Colour Bond
Terra Cotta Tile
Other
Any Asbestos in walls or roof ?
*
Yes
No
Year Constructed ?
*
Number of Stories ?
*
How many Bedrooms ?
*
How many Bathrooms ?
*
Is your home in a flood prone area?
*
Yes
No
Do you require flood cover to be added on?
*
Yes
No
Is the property currently unoccupied?
*
Yes
No
Pool or Spa ?
*
Yes
No
Window Locks ?
*
Yes
No
Deadlocks on external doors ?
*
Yes
No
Alarm System ?
*
Yes
No
If Yes, what type of Alarm system? (Local, Back to base etc.)
CCTV?
*
Yes
No
Unoccupied ?
*
Yes
No
Occupancy ?
*
Owner occupied
Tenant/Renting
Financier/Interested Part:
*
Building Sum Insured:
*
Contents Sum Insured:
*
Do you currently have a Home & Contents policy in place?
*
Yes
No
Do you want your policy to have Accidental Damage cover or Listed Events cover?
*
Accidental Damage
Listed Events
Underwriting question
*
Rows
Yes
No
Do you intend on doing any renovations that exceed $75,000 in the next 12 months?
Do you expect your home to be unoccupied for more than 90 days at any time?
Is your home structurally safe and well maintained?
Do you have any valuables worth more than $10,000 any item or set?
Is your home on acreage?
Do you derive a turnover or run a business from your home?
If Yes to any of the above details:
Is there any further details you need to advise us?
Submit
Should be Empty: