Home Insurance Quote Please complete and submit the below form, and our consultants will be in touch shortly. Full name*Phone*Email* Risk DetailsSituation Address*Postcode*Cover Type*-- please select --Accidental DamageListed/Defined EventsBuilding Type*-- please select --Free Standing HouseTownhouseTerraceApartment / Flat / UnitSemi DetachedDuplexNursing Home UnitIs the property heritage listed?*YesNoWall Construction*-- please select --Brick VeneerDouble BrickAluminiumHardiPlankWeatherboard / WoodMud BrickRoof Construction*-- please select --Steel / Aluminium / Colorbond / IronTiledSlateConcreteFloor Construction*-- please select --TimberConcreteOtherOther*Year Built*Occupancy Type*-- please select --Owner OccupiedHoliday HomeRentalDo you require cover for flooding?*YesNoHas the property been rewired or re-plumbed in the last 20 years*YesNoWhen?*Is the property connected to town water*YesNoIs the land larger than 2 acres*YesNoHow many acres*D.O.B of eldest insured* Date Format: DD slash MM slash YYYY Retired*YesNoIs the property used for business purposes other than a home office*YesNoPlease advise occupation*Currently unoccupied or expected to be unoccupied for more than 60 continuous days*YesNoIs the property well maintained, structurally sound and secured against wind and rain?*YesNoIs the building undergoing renovations greater than $100,000 or, under construction, or, to be demolished?*YesNoIs the property used as a hostel, bed & breakfast or guesthouse*YesNoProperty SecurityAre deadlocks fitted to ALL external doors*YesNoAre key window locks fitted to all external ground floor windows*YesNoAlarm System*YesNoAlarm Type*MonitoredTo mobile phoneTo security companyCover DetailsBuilding replacement value ($)*Contents value (excluding specified items) ($)*Specified items / valuables (additional to above)Item descriptionValue ($) Claims/Duty of DisclosureHave you or anyone to be insured made any claims in last 3 years?*YesNoPlease provide details of loss and amount claimed*Has any insurer refused or cancelled cover or imposed any special conditions?*YesNoHave you or anyone to be insured been convicted of criminal offences during the past 5 years?*YesNoAre there any facts or circumstances that you have not told us about that you know or should know that may affect the insurers decision to insure you?*YesNoFurther information/notesCommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.