• Home Proposal

  • Use this form for a new policy/risk or if adding a risk to an existing policy, include the policy number below.

  • APPLICANT DETAILS

  • Applicant 1 Date of birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Applicant 2 Date of birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.

  • HOW DO YOU WANT TO PAY YOUR PREMIUMS?

  • Direct Debit Payment frequency

  • HOME RISK

  • Risk start date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Renewal date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Please tick your cover type:
  • Have you made any house (excluding contents) related insurance claims within the last 12 months?
  • Is the home on a lifestyle block or farm? If yes, a home on a lifestyle block or farm cannot be covered under this policy.
  • How many self-contained units are at this location?
  • If Home plus units, will any of the units cost less than $300,000 to rebuild? If yes:
  • (These amounts will be each unit's sum insured unless you specify a different amount)
  • How have you arrived at the sum insured?

  • If cordell calculators were used please attached a copy here:

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  • What type of building is the main home?
  • Image field 39
  • How is the home used the majority of the time
  • Is this home part of a multi unit or Body Corporate complex?
  • Does the home have a monitored smoke or heat detector?
  • If pre 1945: Has this home been fully re-wired since 1945?
  • If pre 1945: Has the historic places trust placed any restrictions or preservation orders on this home?
  • If pre 1945: Does this home have any scrim walls?
  • Is there any form of business run from this home?
  • If yes:
  • Are there any entries against the certificate of title for this home?
  • Is there a mortgage on this home?
  • What excess option would you like?
  • Landlord Extension (only available to full time tenanted houses). Do you require?

  • Cover Option Maxi

    Includes Landlord’s furnishings cover for $20,000 (indemnity value), Loss of Rent cover for $40,000, malicious damage by tenant for $30,000 and non-payment of rent by tenant (various limits apply) – per dwelling unit.

  • Cover Option Flexi

    Includes Landlord’s furnishings cover for $5,000 (indemnity value) and Loss of Rent cover for $20,000 – per dwelling unit.

  • Holiday Home Details

  • Is the holiday home leased out on a short term basis?
  • Is this holiday home leased out via website/book a bach/other advertising?
  • Do your immediate neighbours of this property occupy their homes full time?
  • Is the house in a built up area?
  • Do you arrange for anyone to mow your lawns and empty your letter-box?
  • What type of security is there in the house? Does it have an alarm, window locks or deadlocks?
  • Is your holiday home exposed to water inundation from any man made or natural water ways? (including: drains, creeks, rivers, beaches and similar)

  • QUESTIONNAIRE

  • 1. Have you or any members of your family, or any other person or entity to be covered by this insurance: (i) In the past 2 years had more than 2 losses or in the past 2 years made claims totalling more than $2,500?
  • 2. Have you or any members of your family, or any other person or entity to be covered by this insurance, ever: (i) Been aware of any damage from flooding, landslip or earthquake at any address relating to this policy; or
  • (ii) Had any insurance declined, cancelled, renewal refused, terms or conditions imposed or claim declined?
  • (iii) Been engaged in any criminal activity or had any criminal convictions, acquittals or have any criminal prosecutions pending? (The information sought by this question is subject to the rights set out in the Criminal Records (Clean Slate) Act 2004.)

  • 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 to Vero, 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 Vero 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 Vero, and you are willing to accept cover subject to Vero's policy terms, conditions, exclusions and any special terms that Vero may require.

  • PRIVACY ACT

  • Vero 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 Vero may result in your application for insurance being declined.

    Vero 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 Vero that you disagree, the information you supply may also be used by Vero to provide you with information about other facilities, products and services.

    Your personal information is held by Vero. In accordance with the Privacy Act, individuals have a right to request access to and correction of their personal information (a fee may be payable) by contacting Vero, 48 Shortland Street, Auckland 1010.

  • AUTHORISATION

  • You authorise Vero 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 Vero to disclose personal information about you to its related companies (as defined by the Companies Act 1993), all its present and future contracted insurance product manufacturers and / or authorised representatives for these purposes.
  • Where applicant has completed this form personally
  • Date (Applicant 1):
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date (Applicant 2):
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Should be Empty: