Strata Insurance Needs Analysis
Broker Email Address - a copy of the form will be sent to this address
*
example@example.com
Client Reference
*
Date of Enquiry
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Policy Due Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Current Insurer
Who referred client?
Sales Team
Insured Details
Insured Name
Client Postal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: 0000000000.
Current Excess
$
Website
Situation of Risk
City, State, Postcode
Occupation of Tenants
Property Details
Wall Construction
Floor Construction
Roof Construction
ESP?
Please Select
Yes
No
If yes, please provide percentage
%
Is any part of the building heritage listed?
Please Select
Yes
No
Sprinklers
Please Select
Yes
No
Year Built
Number of Levels
Number of Units
Number of Lifts
Number of Playgrounds
Number of Jetties
Number of Water Features
Please Complete for Cladding Construction ONLY
Does the property have cladding?
Please Select
Yes
No
If yes, please provide percentage
%
If yes, please advise full cladding product name
Area/s where cladding is
How has the cladding been affixed to the building?
*Please obtain plan of subdivision
Cover Details
Schedule
Buildings
$
Common Contents
$
Loss of Rent
$
Liability
$
Fidelity Guarantee
$
How many employees with responsibility for money etc?
Do all financial transactions, $1,000 or over, require 2 signatories and/or authorisation by two people?
Please Select
Yes
No
Office Bearers Liability
$
Does the managing agent have Professional Indemnity Insurance?
Please Select
Yes
No
How many members are on the management committee?
Voluntary Workers/Personal Accident
$
Estimated number of voluntary works expected to be engaged at any one time
Machinery Breakdown – Blanket Cover
$
Details of Equipment
Rows
Number of Units
Air-conditioning units
Spa/swimming pool pumps
Compressors, pumps, evaporators, cooling towers etc
Electric Doors
Garage roller doors
Communal clothes dryers/washers
Lift/elevators
Hot water boilers
Control systems
Other
Workers Compensation
Building Catastrophe
Extended cover – Rent/Temporary Accommodation
Escalation in cost of Temporary Accommodation
Cost of Storage and Evacuation
Government Audit Costs
Appeal Expenses – common property health & safety breaches
Legal Defence Expenses
Lot Owner’s Fixtures and Improvements (per lot)
Claims History
For last 5 years
Claim #1
Insurer
Date of Loss
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Details of Claim #1
Amount
Claim #2
Insurer
Date of Loss
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Details of Claim #2
Amount
Claim #3
Insurer
Date of Loss
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Details of Claim #3
Duty of Disclosure
Rows
Yes
No
Has the insured ever had insurance cancelled, declined, or special conditions imposed?
Has the Insured ever been charged or convicted of any criminal offence?
Are any of the units unoccupied? If yes, provide details below
Are the units used as holiday letting (short term leases)? If yes, provide percentage of premises below
Has the insured ever been declared bankrupt or been placed in receivership?
Are there any hazards/defects associated with the property?
If Yes, Please Provide Details
Broker Recommendations
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