You can always press Enter⏎ to continue
General Insurance
Hi there, please fill out and submit this form.
START
1
Contact name
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Contact Date of Birth
-
Date
Day
Month
Year
Previous
Next
Submit
Press
Enter
3
Contact Email Address
example@example.com
Previous
Next
Submit
Press
Enter
4
Contact Phone Number
Previous
Next
Submit
Press
Enter
5
Legal Entity Name
Please provide your personal name if you do not have a company or organisation.
Previous
Next
Submit
Press
Enter
6
Do you want home insurance?
YES
NO
Previous
Next
Submit
Press
Enter
7
Start or Settlement Date
-
Date
Day
Month
Year
Previous
Next
Submit
Press
Enter
8
Property Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
New Zealand
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Previous
Next
Submit
Press
Enter
9
Age of the building
Previous
Next
Submit
Press
Enter
10
Total Floor Area (m2) (including garages, decking, outbuildings etc)
Previous
Next
Submit
Press
Enter
11
Property Type?
Please Select
Owner Occupied
Tenanted
Holiday Home
Please Select
Please Select
Owner Occupied
Tenanted
Holiday Home
Previous
Next
Submit
Press
Enter
12
Is there a mortgage on this home?
YES
NO
Previous
Next
Submit
Press
Enter
13
Who is the mortgage with?
Previous
Next
Submit
Press
Enter
14
Sum Insured (Excluding GST)
*
This field is required.
Visit this link to help calculate Sum Insured - https://sumsure.corelogic.co.nz/#/products/8/profiles/219
Previous
Next
Submit
Press
Enter
15
Select an excess amount you would like to pay
Please Select
$500
$750
$2500
Please Select
Please Select
$500
$750
$2500
Previous
Next
Submit
Press
Enter
16
Any claims in the last 3 years?
YES
NO
Previous
Next
Submit
Press
Enter
17
Any claims - If yes: Please give us the value of the claim AND brief description of the claim
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
18
Has the property suffered any flooding, landslides, erosion or any other natural hazard, or is it located in an area prone to these events?
YES
NO
Previous
Next
Submit
Press
Enter
19
Is the home on a lifestyle block or farm? (under 2.5 acres)
YES
NO
Previous
Next
Submit
Press
Enter
20
Tank/Bore or Town Water?
Please Select
Tank/Bore
Town Water
Please Select
Please Select
Tank/Bore
Town Water
Previous
Next
Submit
Press
Enter
21
Is this building part of a Multi-Unit or Body Corporate Complex?
Please Select
Multi-unit
Body Corporate Complex
No
Please Select
Please Select
Multi-unit
Body Corporate Complex
No
Previous
Next
Submit
Press
Enter
22
Freestanding or Attached?
Please Select
Freestanding
Attached
Please Select
Please Select
Freestanding
Attached
Previous
Next
Submit
Press
Enter
23
How many self-contained units are at this location?
1
2
3
4
5
6
Previous
Next
Submit
Press
Enter
24
Does this home have a monitored smoke or heat detector?
YES
NO
Previous
Next
Submit
Press
Enter
25
Is the house alarmed?
YES
NO
Previous
Next
Submit
Press
Enter
26
Are there any entries against the certificate of title for this home?
YES
NO
Previous
Next
Submit
Press
Enter
27
Is any form of business run from this property?
YES
NO
Previous
Next
Submit
Press
Enter
28
In a few sentences, please provide the business name, industry and description.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
29
Is the house well-maintained, structurally sound, watertight and secure?
YES
NO
Previous
Next
Submit
Press
Enter
30
Do you want content insurance?
*
This field is required.
You’ll benefit from having the same insurer look after both your house and contents insurance.
YES
NO
Previous
Next
Submit
Press
Enter
31
Start/Settlement Date
-
Date
Day
Month
Year
Previous
Next
Submit
Press
Enter
32
Any claims in last 3 years
YES
NO
Previous
Next
Submit
Press
Enter
33
Any claims - If yes: Please give us the value of the claim AND brief description of the claim
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
34
Sum Insured
*
This field is required.
Previous
Next
Submit
Press
Enter
35
Please specify any individual contents items with a value exceeding $3,000
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
36
Select an excess amount you would like to pay
$250
$500
$750
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
36
See All
Go Back
Submit
