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ABN: 12 162 702 025 | AFSL: 444494

Property Quote

Your duty of disclosure

Before you enter an insurance contract, you have a duty of disclosure under the Insurance Contracts Act 1984. If we ask you questions that are relevant to our decision whether to insure you and on what terms, you must tell us anything that you know and that a reasonable person in the circumstances would include in answering the questions. You have this duty until we agree to insure you.

If you do not tell us something

If you do not tell us anything you are required to tell us, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both. If your failure to tell us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed.

By proceeding you confirm you have read and understood this duty

    Start Date

    When would you like your new insurance policy to start?

    Note:This must be within 30 days of today's date

    Where is your home located?

    Address

    Home Details

    How is your home occupied? Are you the:

    In approximately what year was your home built?

    How would you describe your home?

    What level is your flat/unit on?

    What are the exterior walls of your home made of?

    What is the main material used to construct your roof?

    Home security

    Do you have any of the following security devices fitted to your home?

    Door
    Key operated deadlocks on all external doors
    Windows
    Key operated locks on all accessible windowsSecurity grilles / bars on all accessible windows

    Alarm
    Local alarmBack to base alarm


    Policyholder details

    Please enter the date of birth of the oldest policyholder

    Cover options

    What cover do you require?

    Flood Cover

    Do you want flood cover?
    Important Note: If you decide not to take flood cover, you will not be covered for loss or damage caused by flood.


    Property Cover

    What is the current replacement/rebuild value of your property? ($)

    Contents cover

    Choose type of Cover
    Total contents

    What is the replacement value of your total contents?

    Specified contents you want insured in your home
    Do you have any specified contents you would like covered at your home?

    Portable contents

    Portable contents cover allows you to insure items which you wear or carry with you outside your home. These include unlisted portable contents such as your: handbag, wallet, jewellery, and sunglasses as well as listed portable contents such as electronic devices(including mobile phones, laptops, and smart watches)

    Would you like to insure any portable contents which you wear or carry with you outside of your home?

    Valuables and personal effects list:

    Description

    ($)


    Claims / Loss history in the last 5 years

    How many home buildings or contents insurance claims have you or any other person normally residing with you made in the last 5 years?

    Number of Claims

    Year of Claim

    Description of Items claimed

    Value of Claim



    Quote contact details

    First name
    Mobile
    Email
    By providing your contact details, you agree that they can be used to contact you by email and / or phone to assist with this insurance quote and discuss your insurance needs.

    Declaration

    I/ We declare that the best of my/our knowledge and belief the information in this form is true and correct and I/we have not withheld any relevant information.

    I/we consent to the insurance company using my personal information I/we have provided on this form for the purpose of processing my quote. I/we understand that if I/we choose not to provide required details, this is my/our choice, however the insurance company may not be able to provide me with the requested quote.

    I/we consent to the insurance company disclosing my personal information to other insurers, an insurance reference services or as required by law. I/we consent to the insurance company also disclosing my personal information about me, from investigators or legal advisors.

    Please add your Digital Signature here

    Date

    Print Name

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