Commercial Property
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Contact Name
*
First Name
Last Name
Email
*
example@example.com
Postal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you been declined insurance in the past 12 months?
*
Yes
No
Have you had criminal convictions in the past 3 years?
*
Yes
No
Have you had any claims in the last 5 years for the same type of insurance?
*
Yes
No
Unsure
Please provide details of claims history (Date, Claim amount, claim details) - If you are unsure we can request the claims history from the insurer
Insured Name
*
Interested Party
Eg Financier, Local Government Authority
Policy Start Date
*
-
Day
-
Month
Year
Date
Is the property currently insured?
*
Yes
No
Who is the property insured with
*
What company(ie Allianz, CGU, Vero) not the intermediary
Current Insurance Price
*
Property Details
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you owner an owner occupier?
*
Yes
No
Is the property and business owned under the same entity name?
Yes
No
How many tenants are there?
*
1
2
3
4
5 or more
Tenant 1 Business
*
Please enter the tenant's business description
Tenant 2 Business
Tenant 3 Business
Tenant 4 Business
Tenant 5+ Business
Flood Cover?
*
Yes
No
Is the property heritage listed?
*
Yes
No
Is the property fully occupied?
*
Yes
No
Does your property contain EPS?
*
Yes
No
When was the property Built
*
Approx
Has the property been rewired in the last 15 years?
*
If so what year
Property Construction Details
*
eg double brick, brick veneer, hebel, concrete, wood
Construction of Roof
*
eg Tiles, Metal, Colourbond, Steel etc
Construction of Floor
*
eg Wood, concrete
Fire Protection Details
*
Fire Extinguisher
Fire Alarm
Smoke Detectors (unmonitored)
Smoke Detectors (Monitored)
Fire Blankets
Sprinklers
Hose Reels
None
Security Details
*
Local Alarm
Monitored Alarm
CCTV
Deadlocks on Doors
Watchman Patrols
Bars on Windows
Security Fencing
External Lighting
Roller Shutters
None
Cover Details
Property Sum Insured
*
Contents Sum Insured
Stock
Excess
*
Rental Income
*
per year
Estimated outgoings
*
Would you like cover for Business Interruption
*
Yes
No
Indemnity Period
12 months
24 months
Glass
*
Yes
No
Public Liability
*
$10 million
$20 million
Equipment Breakdown
*
Yes
No
Cover Amount Required
Please Select
$10,000
$15,000
$20,000
$30,000
$50,000
Other
Do you require cover for Air-Con?
*
Yes
No
Notes
Upload any previous policies or relevant info
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