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?* Yes No Wall 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?* Yes No Has the property been rewired or re-plumbed in the last 20 years* Yes No When?* Is the property connected to town water* Yes No Is the land larger than 2 acres* Yes No How many acres* D.O.B of eldest insured* DD slash MM slash YYYY Retired* Yes No Is the property used for business purposes other than a home office* Yes No Please advise occupation* Currently unoccupied or expected to be unoccupied for more than 60 continuous days* Yes No Is the property well maintained, structurally sound and secured against wind and rain?* Yes No Is the building undergoing renovations greater than $100,000 or, under construction, or, to be demolished?* Yes No Is the property used as a hostel, bed & breakfast or guesthouse* Yes No Property SecurityAre deadlocks fitted to ALL external doors* Yes No Are key window locks fitted to all external ground floor windows* Yes No Alarm System* Yes No Alarm Type* Monitored To mobile phone To security company Cover DetailsBuilding replacement value ($)*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?* Yes No Please provide details of loss and amount claimed*Has any insurer refused or cancelled cover or imposed any special conditions?* Yes No Have you or anyone to be insured been convicted of criminal offences during the past 5 years?* Yes No Are 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?* Yes No Further information/notesNameThis field is for validation purposes and should be left unchanged. Δ