• Home Building &/or Contents Insurance Quotation Questionnaire

  • Thank you for your enquiry regarding Home Building &/or Contents Insurance coverage.

    Please complete and submit this questionnaire to enable us to obtain quotes on your behalf.

    Please remember that insurance companies rely on the information that you provide to decide whether they will insure you and on what terms/conditions. Before entering into an insurance contract all of the persons and/or entities to be insured have a Duty of Disclosure to supply truthful, complete and accurate information. If you fail to comply with the Duty, the insurer may by entitled to reduce or decline claims.

  • We are committed to protecting your privacy in accordance with the Privacy Act 1998 (Cth).

    We do not sell, trade, or rent your personal information to others.

    Please contact us if you would like a copy of our full Privacy Policy to be forwarded to you.

  • Client Details

  • Cover Date

  • Do you require cover to begin on a particular date?*
  • If yes, please select date:*
     - -

  • Current Insurance

  • Do you currently have Home Building &/or Contents Insurance?*
  • Current Expiry Date*
     - -
  • Do you currently pay*

  • Insured Details

  • The property is owned by*
  • Is Insured 1 retired?*
  • Is there a second Insured Person?*
  • Is Insured 2 retired?*
  • Is there a third Insured Person?*
  • Is Insured 3 retired?*
  • Is there a fourth Insured Person?*
  • Is Insured 4 retired?*

  • History

  • During the last 5 years have any of the Insureds had:

  • Any type of loss or damage (whether claimed or not) for home building and/or contents?*
  • Any application for home insurance rejected?*
  • Any home policy cancelled by an insurance company?*
  • Any special conditions set by an insurer on a home policy?*
  • Renewal of an existing home policy not offered by the insurer?*
  • Any increased excess imposed on a home policy?*

  • During the last 5 years have any of the insured individuals or company directors had any criminal conviction relating to:

  • Actual of threatened damage to property?*
  • Fraud / Theft / Drugs?*
  • Dishonesty of any kind?*

  • Have any of the insured individuals or company directors:

  • Ever been declared bankrupt?*

  • Interested Parties

  • Do any other parties hold a financial interest in the property to be insured? (ie mortgage)*

  • Property Situation

  • Property Type

  • Does the building share any common walls with neighbouring villas/townhouses?*
  • How many storeys is the building?*
  • The apartment/unit is*
  • Is the building situated in a retirement / lifestye village?*
  • Is the building situated in a caravan / mobile home park?*
  • Is the building listed?*
  • Is the building situated on a property of more than 2 acres?*
  • In the last 10 years has the land where the building is situated been flooded or inundated by water?*
  • Is the property within 250 metres of a named watercourse (eg Swan River, Herdsman Lake)?*
  • Is the property attached to mains water?*
  • The property has*
  • Is the property currently under construction or demolition?*
  • Is the property currently undergoing renovations of more than $50,000?*
  • Is the property well-maintained and in good condition?*
  • Bedrooms*

  • Bathrooms*

  • Study / Office areas*

  • Will any part of the property be used for earning income other than residential rental income?*
  • How many unrelated people occupy the building? (ie housemates, boarders)*

  • Building Construction

  • Has the building been*

  • Occupancy

  • How often will the property be occupied?*

  • Are there permanently occupied residences within 100 metres of the property?*
  • What date did the property become unoccupied?*
     - -
  • What date is the property expected to become occupied again?*
     - -

  • Security / Protection

  • Doors (excluding sliding)*
  • Sliding doors*
  • Windows (excluding louvres)*
  • Louvre windows*
  • Alarm system*
  • Other protection*

  • Covers and Sums Insured

  • Building(s)

  • Is cover required for the building?*

  • The Building Sum Insured must be for the full replacement cost of the building including outbuildings, fencing, paving, driveways, swimming pools etc.

    Click here for a link to assist you in calculating your Building Sum Insured:

    http://secure.cordell.com.au/valuer_residential/index.php?p=45&from_admin=1

    Typical building replacement costs are provided by Reed Business Information Pty Ltd (A.B.N. 80 132 719 861) trading as Cordell Information (‘Cordell’). Whilst every care is taken to ensure the accuracy of the information as a guide for costing, no responsibility is accepted by either Cordell, SI, Steadfast or the Steadfast Broker for its accuracy. Please check with an Architect, Builder, Quantity Surveyor, Valuer or other suitably qualified professional for an accurate estimate. Neither Steadfast nor the Steadfast Broker takes any responsibility for the costs provided by Cordell or SI nor any liability for the accuracy of or reliance upon or use of, the costs. To the fullest extent permitted by law, Cordell, SI, Steadfast and the Steadfast Broker expressly disclaim all warranties, express or implied, including, but not limited to, the implied warranty of fitness for a particular purpose. Cordell, SI, Steadfast and the Steadfast Broker do not warrant or make any representations regarding the use or the results of the use of the information provided in terms of its correctness, accuracy, reliability, or otherwise.

  • Contents / Fixtures / Fittings

  • Is cover required for the contents / fixtures / fittings?*

  • The Contents Sums Insured must be for the full replacement cost of the contents, which may include but are not limited to:

    - carpets, internal blinds and curtains

    - swimming pools and spas not permanently fixed

    - furniture, furnishings and household goods that are not built in

    - fixtures and domestic structural improvements inside a Strata Title unit that are not insured by the Body Corporate

    - portable domestic appliances and/or electronic equipment that are not built in (these must be specified on the policy)

    - antiques, works of art or collections of any kind (these must be specified on the policy)

  • Do you require cover for Specified Contents items?*

  • Valuable Items / Personal Effects

  • The Valuable Items or Personal Effects section covers items for which you require cover at any place away from your home address. It can include but is not limited to:

    - jewellery and watches

    - items that contain gold or silver (but not items only thinly covered with gold or silver)

    - furs

    - individual items or collections of stamps, money, medals etc

    - personal electrical devices such as hearing aids, iPods, mobile phones, laptops & tablets

  • Do you require cover for Valuable Items / Personal Effects?*

  • Domestic Workers' Compensation (to cover any domestic employees and/or any contractors that may not be covered by a Workers' Compensation policy)

  • Do you require cover for Domestic Workers' Compensation?*

  • Other Details

  • Are you concerned about cover under the policy for any particular item or event that has not already been detailed in this questionnaire?*
  • Would you like to advise us of anything else that you think we may need to be aware of?*

  • Policy Options

  • Level of Coverage

  •  

    In most cases we are able to obtain quotes for one of the 3 following coverage types. Where that type is not available in your particular circumstances, our quote will be based on the next level up.

     

    Lowest level: Budget

    Also known as: Listed Events Base, Essentials

    You're only interested in price, not what's covered under the policy. You want the type of budget policy that you could buy off the internet from any other company, but you still want to deal with a broker.

    We don't recommend this cover, as you'll likely be disappointed by the outcome when you make claims.

     

    Mid level: Defined Events

    Also known as: Listed Events, Extra, Extra Care, Classic, etc

    You don't want budget cover, but you also don't want anything beyond basic standard cover. You don't want to cover Accidental Damage to your building and/or contents (except glass breakage, which is automatically covered). You probably don't have any valuables (jewellery, portable electronics, antiques, art, collections, etc) to cover that are worth more than $1,000 per item (if you do, you can specify them on the policy, however it may be more economical to move up to the next level).

     

    High Level: Accidental Damage

    Also known as: Elite, Elite Care, etc

    You want the top cover that you can get, with as many included extras as you can get - after all, that's why you use a broker. You want full Accidental Damage cover for your building and/or contents, and you want some automatic cover for valuable items as well.

  • What level of coverage are you looking for?*

  • Excess

  • Most insurers now have a compulsory basic excess on all claims of between $500 and $600 (some insurers will make you pay an additional excess for claims such as earthquake or flood).

    However, you may be able to reduce the premium payable for the policy by taking a voluntary increased excess on claims.

  • Are you interested in taking an increased excess option?*

  • Flood

  • In general terms "flood" means the covering of normally dry land by any water (including snow melt):

    * escaping or released from the normal borders of:

       - any lake or natural watercourse, whether or not altered or modified, or

       - any reservoir, canal, dam, or stormwater channel, or

    * that, because of water that has already escaped or been released, cannot enter:

       - any lake or natural watercourse, or

       - any reservoir, canal, dam or stormwater channel

    whether in the immediate region or elsewhere.

    Whilst some insurance policies do include flood as standard, most require that you take flood as a policy option if you require the cover.

  • Do you require a policy that includes flood cover?*

  • Declarations

  • I am satisfied that the information that I have provided in this questionnaire is accurate and complete.

  • I understand that the submission of this form is a request for a quotation only. No cover will be in place until such time as you have accepted our quotation in writing, the insurer has agreed to cover you, and you have complied with any of their requirements (ie payment, application form, etc).

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