Please complete the following form and one of our staff members will return your enquiry:

Type of Insurance Required

Home and Contents Insurance Quote

Policyholder One Full Name:
Policyholder One Date of Birth:
Policyholder One Occupation:
Policyholder Two Full Name:
Policyholder Two Date of Birth:
Policyholder Two Occupation:
Property Location:
Postal Address (leave blank same):
Telephone (Home):
Telephone (Work):
Telephone (Mobile):
Email Address:

Construction of Exterior Walls:


Building Usage:





Building Occupied by:

Is any commercial business conducted at the property?

Have any of the following been installed?
Deadlocks on Doors / Window
Electrical Safety Switch
Smoke Alarms
Security Alarm
Patio bolts on any sliding doors


Building Policy Cover: You need to insure for an amount sufficient to rebuild your house with its improvements, removal of debris and professional fees.


Size (no. of squares or square metres):


Approximate Year Built:



Number of Bedrooms:

Highset / Lowset:

If your house is older than 50 years, has it been rewired in the last 25 years?

Building Sum Insured
$

Contents Policy Cover: You need to insure for an amount sufficient to replace all your contents at today’s purchase price for comparable new items.

Contents Sum Insured: (Please include the value of Special Items of General Contents and Home Computers in your Contents Sum Insured.) 		$


Special Items which need to be listed (if valued over $1,000 with a supplied valuation):
Articles of Jewellery $
Watches $
Furs $
Items containing Gold or Silver $
Precious Stones $
Pictures and Works of Art $
Persian or similar Rugs or Carpets $
Curios or Antiques $
Documents $
Collections $

Musical Instrument (other than piano/organ)

 $

Property used in an Office or Surgery if the total value exceeds $5000

 $

Home Computers (hardware, accessories and software are limited to $5,000 in all unless listed below). Please provide year, brand, model and serial numbers:
Computer One Details $
Computer Two Details $
Computer Three Details $

Previous History:

Name of Previous Insurer:
Have you ever had insurance cancelled or declined?
Have you ever had any criminal convictions?
Have you had any household losses in the past 5 years?
If you answered yes to any of the above please enter details including year, circumstances, Insurance company and value involved :

I agree to the Terms & Conditions


 





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