Domestic Fact Find - Over50 Logo
  • Domestic Fact Find

  • Introduction

  • Applicant 1

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  • Applicant 2

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  • Trustee 1

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  • Trustee 2

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  • Home Risk Section

  • Home 1: Details

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  • (These amounts will be each unit’s sum insured unless you specify a different amount)

  • Please note:

    Identified exposures affecting a property will be noted against the certificate of title (and noted within the LIM). An example would be an entry in relation to Section 71 of the Building Act 2004, or Section 36 of the Building Act 1991 or any Section 72, 28 or 51 notices.

  • The sum insured amount should represent the cost of rebuilding the existing home and any self-contained unit(s) (including all improvements at your property).

    Calculator: Sum Sure (corelogic)

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  • Holiday Home 1: Details

  • Home 2: Details

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  • (These amounts will be each unit’s sum insured unless you specify a different amount)

  • Please note:

    Identified exposures affecting a property will be noted against the certificate of title (and noted within the LIM).  An example would be an entry in relation to Section 71 of the Building Act 2004, or Section 36 of the Building Act 1991 or any Section 72, 28 or 51 notices.

  • The sum insured amount should represent the cost of rebuilding the existing home and any self-contained unit(s) (including all improvements at your property).

    Calculator: Sum Sure (corelogic)

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  • Holiday Home 2: Details

  • Contents Risk Section

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  • Click here to use the calculator: House Contents Calculator

  • SPECIFIC ITEMS

  • If you would like to insure items for their full value, please specify each item in the space provided below.  The values (and the items themselves) that you specify below will be insured in addition to your ‘general contents sum insured’ above.  Some items will require valuations.

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  • Vehicle Risk Section

  • Vehicle 1: Details

  • Comprehensive cover options

  • Vehicle 1: General Information

  • Vehicle 2: Details

  • Comprehensive cover options

  • Vehicle 2: General Information

  • Driver Details

  • This part requests information on the previous insurance history of your vehicles.

  • TRAILER, CARAVAN OR HORSE FLOAT, MOTORCYCLE

  • Boat Risk Section

  • Boat: General Details

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  • Cover Required

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  • Boat: Location

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  • Boat: General Information

  • Questionnaire Section

  • Have you or any members of your family, or any other person or entity to be covered by this insurance

  • Important Notices and Declaration Section

  • Duty of Disclosure
    Subject to any rights you have under the Criminal Records (Clean Slate) Act 2004, the information given is in every respect correct and complete and all material information has been disclosed, whether the information is asked for or not. Material information is information that might influence our decision to insure you and if so on what terms and / or premium. If you have any doubt as to whether a fact is material then it must be disclosed. The duty to disclose all material information occurs prior to the commencement of cover, if the contract is varied and prior to each renewal. Failure to disclose all material information may result in the insurer avoiding your insurance policy. This means your policy would be deemed never to have existed and any claims would not be payable. The information contained in this document shall be the basis of the contract between you and the insurer, and you are willing to accept cover subject to the insurers policy terms, conditions, exclusions and any special terms that the insurer may require.

    Privacy Act 2020
    The brokerage has collected your personal information in order to evaluate your insurance requirements for the purpose of deciding whether to issue insurance cover and, if so, on what terms. Failure to provide any personal information requested by the brokerage may result in your application for insurance being declined. The brokerage has also collected your personal information in order to monitor and service your ongoing general insurance requirements, conduct market research, data processing and statistical analysis. Unless you notify the brokerage that you disagree, the information you supply may also be used by the brokerage to provide you with information about other facilities, products and services. Your personal information is held by the brokerage. In accordance with the Privacy Act 2020, individuals have a right to request access to and correction of their personal information (a fee may be payable) by contacting the brokerage.

    Authorisation
    You authorise the brokerage to give to and obtain from other Insurance Companies, Insurance Brokers, the Insurance Claims Register Ltd or any other party, any information relating to this or any other insurance held or previously held by you, and any claim(s) made by you, and any information you have provided now or previously for the purpose of payment. You also authorise the brokerage to disclose personal information about you to it’s related companies (as defined by the Companies Act 1993), all it’s present and future contracted insurance product manufacturers and / or authorised representatives for these purposes.    

    Recieving Information from us
    As a client of Kumeu Insurance Services you will receive ongoing material from us such as renewal information, endorsement notices and letters from your insurer as part of our service to you. We will email this to you unless your preferred method of receiving this type of communication from us is by post.

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