Landlords Fact Find / Review
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Insured Details
Insured Person(s):
*
Full name(s) of all persons insured
Date of Birth:
*
Date of birth of all persons insured
Postal Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Prior Claims?
*
Yes
No
If Yes, please provide details
Provide any information regarding previous claims
Are you currently insured?
*
Yes
No
If Yes, Please provide the name of insurer and your due date?
*
If uninsured please note n/a
Please advise your current premium?
*
The amount due on your existing policy
Please advise your requested excess?
*
Criminal Convictions?
*
Yes
No
If Yes, please provide details
Provide details regarding any criminal convictions
Have you ever been declared bankrupt?
*
Yes
No
Contact Number:
*
Email:
*
example@example.com
Preferred Contact Method:
*
Phone
Text
Email
Property Details
Property Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date of Policy:
-
Day
-
Month
Year
Date policy will need to begin
End Date of Policy:
-
Day
-
Month
Year
Date policy will end
Type of Property:
*
Please Select
House
Unit
Townhouse
Duplex
Walls:
*
Please Select
Brick
Brick Veneer
Weatherboard
Hardiplank
Concrete
Other
Any asbestos in external walls or roof
*
Yes
No
Is the property currently tenanted?
*
Yes
No
Is your home in a flood prone area?
*
Yes
No
Do you require flood cover to be added on?
*
Yes
No
Roofing:
*
Please Select
Iron
Cement Tile
Colour Bond
Terra Cotta Tile
Other
Strata Titled?
*
Yes
No
Year Constructed:
*
Stories/Levels:
*
How many Bedrooms
*
How many Bathrooms
*
Pool or Spa?
*
Yes
No
Window Locks?
*
Yes
No
Deadlocks on external doors?
*
Yes
No
Alarm System?
*
Yes
No
If Yes, please provide details
CCTV?
*
Yes
No
Unoccupied?
*
Yes
No
Building Sum Insured:
*
Contents Sum Insured:
*
Excess:
*
Weekly Rent:
*
Annual Rent:
*
Would you like rent default cover?
*
Yes
No
Would you like loss of rent cover?
*
Yes
No
Managed by an agent?
*
Yes
No
Long term tenants over 3 months?
*
Yes
No
Financer/Interested Party:
*
If there is none please type N/A
Underwriting Questions:
*
Yes
No
Do you intend on doing any renovations that exceed $75,000 in the next 12 months?
Do you expect the property to be unoccupied for more than 90 days at a time?
Is your home structurally safe and well maintained?
Is your home on an acreage?
If Yes to any of the above, please provide details:
Are there any further details you need to advise us?
Submit
Should be Empty: