Personal Insurance Quote

Personal Insurance Quote

If you need any help with this form please contact Insure Taranaki.

General Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Date of Birth*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Home
In what year was your home built?*
Occupancy Type*
Cost to rebuild house (ex GST)*
What is the sqm of the house including any attached garages?*
Do you have another house?*

YesNo
What is the address of the second property?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the occupancy type of the second property?
What is the sqm of the second house including any attached garages?
When was the second house built?
What would be the cost to rebuild the second house (ex GST)?
Do you have a third house?

YesNo
What is the address of the third property?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the occupancy type of the third property?
What is the sqm of the third house including any attached garages?
When was the third house built?
What would be the cost to rebuild the third house (ex GST)?
Do you have a fourth house?

YesNo
What is the address of the fourth property?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the occupancy type of the fourth property?
What is the sqm of the fourth house including any attached garages?
When was the fourth house built?
What would be the cost to rebuild the fourth house (ex GST)?
Do you have a fifth house?

YesNo
What is the address of the fifth property?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the occupancy type of the fifth property?
What is the sqm of the fifth house including any attached garages?
When was the fifth house built?
What would be the cost to rebuild the fifth house (ex GST)?

Contents, Vehicles
Do you have a working burglar alarm?*

YesNo
Contents sum insured?*
Do you have items of jewellery or cameras over $5,000, please specify below:

Vehicles

	Age of Vehicle	Rego Number	Market Value
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5
Vehicle 6

Unsure of the market value?

Please go to https://www.driven.co.nz and use the market value online calculator.

Confirm & Send
Privacy Policy

Pursuant to the Privacy Act 2020 the following is brought to your attention. We have collected information about you in the process of providing you with an Insurance quote. The information has been collected to evaluate the insurance you seek and is required pursuant to the common law duty to disclose all material facts relevant to the insurance sought and is mandatory. You have the right of access to and correction of this information, subject to the provisions of the Privacy Act 2020.
I, have read the privacy policy above.*

Yes
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