YG General - House and Content Insurance Questionnaire

Is this insurance for a newly purchased house or for your existing house?*

Who is your existing insurance company?*

(eg AMI, AA, State, Vero)

Which entity is the house registered under?*

* What is the legal registered name of the Trust or the company?*

(please write the full legal name)

Owner Name 1*

PrefixFirst NameMiddle NameLast Name

Date of Birth*

Date

Are there any other owners of the property?*

Owner Name 2*

PrefixFirst NameMiddle NameLast Name

Date of Birth*

Date

Owner Name 3

PrefixFirst NameMiddle NameLast Name

Date of Birth

Date

Is the owner the main contact person?

Contact Person's Name*

PrefixFirst NamePreferred NameLast Name

Contact Mobile Number*

(must be a New Zealand number)

Contact Email*

example: abc@abcdefg.com

Contact Address*

Street & Suburb

Street Address Line 2

City & Postal/Zip Code

Is the postal address different?*

Postal Address *

Street & Suburb/ Po Box

Street Address Line 2

City & Postal/Zip Code

Address of the house to be insured*

Street & Suburb

Street Address Line 2

City & Postal/Zip Code

Which year was the house built?*

Is this a new build?*

YESNO

Do you have Code of Compliance Certificate (CCC) on this property?*

YESNO

What type of material is the roof?*

Eg :

What type of material is used for flooring?*

Eg:

What type of material is used for exterior walls?*

Eg:

How many stories/levels is the house?*

Does the house have a security alarm?*

YESNo

Does the house have a smoke alarm or heat detector?*

YES, I have monitored alarm (Eg: fire truck will arrive)YES, but it's unmonitored (Self monitored)No

Are there any rules, limitations and or restrictions on the Certificate of Title? (Eg : Easement, Caveat, Covenant, Lease, Right of way)*

YESNo

If YES please give the details.*

	YES	No
Easement: A legal right allowing the neighboring property to use part of the land for access or utilities
Caveat: A notice lodged by someone claiming an interest in the property, preventing changes without notifying them.
Covenant: A restriction on how the property can be used (e.g., no commercial activity)
Lease: A long-term lease agreement registered on the title.
Right of Way: A legal right for others to pass through the property.
Others

Please comment on other restrictions

Is the house planning to run a business?*

YESNo

Did you buy your house with a Mortgage? If yes, please write the full name of bank or Mortgage provider. If not, please write N/A. *

When is the settlement date*

Date

Was this house built before 1945?*

Is this house registered as a historic place or listed with Heritage New Zealand?*

YESNO

Please answer the questions for the 'internal walls':*

	What % is the internal walls made of?	Condition: NEW	Condition: Very Good	Condition: Average	Condition: Poor
Gib board/ Plaster
Scrim & Paper
Match Lining
Pines/Other

Please answer the questions for the 'roofing':*

	What is it made of?	Condition: NEW	Condition: Very Good	Condition: Average	Condition: Poor
Roofing material

Please answer the questions for the 'external walls':*

	Concrete - please write %	Wood - please write %	Other Materials - please write %
What is it made of? (total should be 100%)

What improvements are made to the house?*

	YES	If 'yes' - what year?	No
Repiled?
Chimney Rebricked?
Replumbed?
New Kitchen?
New Bathroom?

Please answer if the house is fully rewired? *

If you answered 'Yes' - which year, did it get rewired?*

If you answered 'No' - do you have an electrical certificate?*

Please attach your files here

Is it a Lifestyle Block or a Farm?*

Is it a part of Body Corp or Multi Unit?*

* If you answered 'YES' to a Lifestyle Block or a Farm, please complete.*

	YES/NO. If you answered 'yes' please provide details (what, how many)
Is there any barns or shed?
Is there any crops on land?
Is there any animals on the land?
Is there any commercial use of land or property?
What is the size of the land? (sq.metre)

* If you answered 'YES' & it's a part of Body Corp or Multi Unit, please complete.*

	Please write your answers here
Is there a firewall between the units? (this reduces the spread of fire to other units)
Are there any shared common areas? (eg - shared stairway, shared carpark, swimming pool etc)
Is it a single or a double storey ?
Does the unit belong to a bodycorp?

Sum Insured (excluding GST)*

We need GST exclusive amount.

* Please click here to get a Cordell Report for your house.

https://sumsure.corelogic.co.nz/#/products/8/profiles/219

IT IS IMPORTANT that you visit Cordell and enter your street address to find out the cost to rebuild your house.

PLEASE ensure you do this step especially if its a new build and attach the Cordell Report for our reference.

Please upload the Cordell report if you've obtained one

Total Floor Area of the house*

(sq.meters) Please include all the areas, e.g., deck, garage, etc.

Total Number of Dwellings on this house*

(if the house has a minor dwelling, that would be '2' dwellings)

The house water is*

Town suppliedOther (eg - Rainwater)

What is the occupancy status?*

Please answer all of the following if you selected "Owner+unrelated flatmates" for occupancy question:*

	Name	Age	Occupation	How long have you known them?	Do they have their own content cover? who with?
1
2
3
4
5

If unoccupied now, how long will it be empty? *

If it is a tenanted property, please provide information on who manages the tenancy and the weekly rent amount.*

Please choose excess option for the insurance quote*

$400$500$750$1250

If you want more than one excess option, please write here:

Do you require content insurance on this property?*

	Please describe the item and be specific. The more information, the better at claim time.	Value $ (NZD)
Specific Item 1 (eg - 1carat diamond ring)
Specific Item 2 (eg -
Specific Item 3
Specific Item 4
Specific Item 5

	Yes	No	if you answered 'Yes' please comment your details here.
Is the house well-maintained, structurally sound, watertight, and secure?
Has the house ever been aware of any damage from flooding, landslip, or earthquake at any address relating to this policy
Had any insurance declined, cancelled, renewal refused, terms or conditions imposed or claim declined
Been engaged in any criminal activity or been acquittal

House Insurance Questionnaire

Owner Details

House to be Insured

Content Insurance

Customer Declaration

Declaration on claims

Thank you for completing the form. We will come back to you soon.