Home and Contents Insurance
Proposal Form
*
Rows
Applicant 1
Applicant 2
Full Name
Date of Birth
Contact Number
Email
RACQ Membership Level
Are you Retired?
Do you have a Seniors Card?
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PROPERTY DETAILS
Address of Property
Street Address
Street Address Line 2
Town
State
Postcode
Type of Building
*
Please Select
House
Flat/Apartment
Unit
Terrace
Townhouse
Semi-detached
Occupancy
*
Please Select
Owner Occupied
Tenant
Landlord
Holiday Home
Unoccupied
Wall Construction
*
Please Select
Double Brick
Brick Veneer
Concrete Blocks
Colorbond/Iron
Fibro/Asbestos
Hardiplank/Hardiflex
Timber/Weatherboard
Other (specify)
If wall construction is other, please specify below
Roof Construction
*
Please Select
Corrugated Iron
Colorbond
Aluminum
Tile
Fibro/Asbestos
Concrete
Other (specify)
Built on
*
Please Select
Concrete Slab (no space between ground and floor)
Stumps/foundation (clear space between ground and floor)
Queenslander/Poles elevated off ground up to 1m
Queenslander/Poles elevated off ground up up to 2m
Queenslander/Poles elevated off ground over 2m
Year Built
*
Rows
Number of Storeys
Number of Bedrooms (inc study/office)
Number of Bathrooms
Do you have a Pool?
*
Yes
No
Do you have a Spa?
*
Yes
No
Security
*
Standard Locks on doors
Deadlocks on external doors
Security Screens on external doors
Window locks
Security Screens on windows
Monitored Alarm system
Non-Monitored Alarm system
Other
Solar Panels
*
Please Select
No Solar Panels Fitted
Standard Solar Panels Fitted
Hail ‘Resistant’ Panels Fitted
Roller Doors (not tilt doors)
*
Please Select
No roller doors
Rollers doors no bracing
Roller doors with aftermarket bracing fitted
Roller doors fitted after 2012
Roof Improvements
*
Please Select
No Improvements (original roof)
Rescrewed
Ridgcapping replaced/upgraded
Complete roof replacement (form 16 compliant)
Roof cladding replaced and sarking installed
Sheds/Outhouses
*
Please Select
None
Sheds/outhouses with NO cyclone protection
Sheds/outhouses cyclone rated and anchored to concrete slab
Sheds/outhouses cyclone rated but NOT anchored to concrete slab
Do ALL windows have
*
Cyclone Shutters
Plywood Covering
Storm Shield / Tempered Glass
No Cyclone Protection on Windows
Mortgagee/Interested Party
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INSURANCE DETAILS
Rows
Sum Insured
Excess
Cover
Building
$500
$750
$1,000
$2,000
$2,500
$3,000
$4,000
$5,000
Defined Events
Accidental Damage
Contents
$500
$750
$1,000
$2,000
$2,500
$3,000
$4,000
$5,000
Defined Events
Accidental Damage
Unspecified Contents/Valuable Items
*
Please Select
No
$1,000 per item - $2,000 total/per claim
$1,500 per item - $5,000 total/per claim
$5,000 per item - $10,000 total/per claim
$10,000 per item up to 25% of the Contents Sum Insured in Total
eg Jewellery, watches, electronics, memorabilia, collections,
Specified Contents / Valuable Items
Rows
Description
Sum Insured
Do you have a current valuation
Yes
No
Yes
No
Yes
No
How many years have you held home/contents insurance?
How many years have you been claims free?
Name of your previous/current insurer
What date would you like the policy to start?
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DECLARATIONS
*
Rows
Is the Property structurally safe, well maintained and in Good Condition?
Yes
No
Is your home on more than 5 acres?
Yes
No
Do you expect your home to be unoccupied for more than 90 consecutive days?
Yes
No
Do you derive a turnover or run a business from your home?
Yes
No
Do you intend on doing any renovations that exceed $75,000 in the next 12 months?
Yes
No
Had an insurance policy cancelled, declined or terms imposed?
Yes
No
Have you been convicted of any criminal offence?
Yes
No
Have you had any claims in the past 5 Years?
Yes
No
If YES to any of the above, give details below:
Submit
Should be Empty: