• Quote Request Form

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    • Your Duty of Disclosure 

    • Before you enter into a contract of insurance you have a duty to answer all questions honestly and to tell us anything known to you, and which a reasonable person in the circumstances would include in answer to the questions.

      We will use the answer in deciding whether to accept the risk of insurance and, if so, on what terms. You have the same duty to disclose those matters to us before you extend, vary or reinstate this contract.

      If you fail to comply with your Duty of Disclosure, we may be entitled to reduce our liability under the contract in respect to a claim, refuse to pay a claim or may cancel the contract. If your non-disclosure is fraudulent, we also have the option of avoiding the contract from its beginning.

    • Our Privacy Act Statement 

    • We gather information about you (including your claims history) to consider your application for insurance. Your duty of disclosure requires you to do this. If you refuse to provide the information, we may decline your application or declare this policy unenforceable from the beginning.

      This information is held by us and you may access and seek correction of it. It may be passed on to other insurers you deal with, and interested parties.

      Your claims history is passed on to, and held by, Insurance Claims Register Ltd. This enables other insurers you deal with to access it, and prevents fraudulent claims.

    • Our Disclosure Statements 

    • Builtin Insurance Brokers Limited holds a full Class 2 Financial Advice Providers license, which came into effect on 5th September 2022 and replaced our transitional license. Our registration number is: FSP28581. Click here to view our registration details. This Financial Advice Providers license also covers Builtin New Zealand Limited (FSP200907) as an Authorised Body. We are regulated by the Financial Markets Authority (FMA).

      See our disclosure statements here.

  • BUSINESS DETAILS

  • Choose your trade (you can add multiple)*
  • Type of work you mostly do

  • CHOOSE THE POLICIES YOU'D LIKE TO INCLUDE

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  • LIABILITY

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  • TOOLS & EQUIPMENT

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  • COMMERCIAL VEHICLES

  • Details of each vehicle to be insured, including trailers*

  • HAVE YOU OR ANYONE ELSE WHO WILL DRIVE THE VEHICLES:

  • In the last three years, had any single vehicle claim over $10,000?*
  • In the last three years, been disqualified from driving, had a driver's license endorsed, suspended or cancelled, or been charged with logbook offences or of driving outside the worktime rules?*
  • Had more than 2 speeding fines in the last 2 years?*
  • Had previous insurance cancelled or any special terms imposed by an insurer?*
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  • ANNUAL CONTRACT WORKS

  • Have you previously held contract works/builders risk insurance?*
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  • PERSONAL RISK

    Life, trauma, health, income protection and Kiwisaver

  • CLAIMS HISTORY & GENERAL

  • Have you, or any principal, partner or director, had any accidents, claims or losses, whether or not the subject of an insurance claim, in the past 3 years?*
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  • In the last 7 years has any insured person had insurance declined, cancelled or refused by an insurer?*
  • Has any insured person ever been imprisoned, charged with or convicted of a criminal offence? You don't need to include convictions covered by the Criminal Records (Clean Slate) Act 2004.*
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  • YOUR DETAILS

  • OTHER DETAILS

  • AGREEMENT

  • Date of agreement*
     - -
    2 digit day, 2 digit month, 4 digit year
  • *
  • Have you had any insurance policy or application for cover:*
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