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Quote Form Commercial Strata (Obsolete)
Contact Details
Situation at Risk
Insurance Options
Insurance History
Additional Information
Contact Details
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Contact Person:
Email Address:
Phone Number/Mobile:
Business Details
Business Structure:
Company
Incorporated Association
Other
Partnership
Personal
Private Company (Pty Ltd)
Publicly Listed Company (Ltd)
Self Managed Superannuation Fund
Sole Trader
Superfund
Trust
Company or Insured Name:
Trading As:
ABN No.:
Registered for GST:
Yes
No
Mailing Address
Address Line 1:
Address Line 2:
Town/Suburb:
Postcode:
State:
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Situation at Risk
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Property Address
(Cannot be a PO Box)
Address Line 1:
Address Line 2:
Town/Suburb:
Postcode:
State:
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Is the property part of a strata title?
Yes
No
Is the property used for business purposes other than a home office or surgery?
Yes
No
Is the property under construction, reconstruction or renovation?
Yes
No
Is the property poorly maintained, in disrepair, or in bad condition?
Yes
No
Is the property currently unoccupied or expected to be unoccupied for more than 90 continuous days?
Yes
No
Is the property under any heritage listing / national trust listing or order?
Yes
No
Is the property used as a hostel, bed and breakfast or guesthouse
Yes
No
Is the property used for community housing or public housing?
Yes
No
Please provide details regarding the previous question/s where applicable
How is your home occupied? Are you the:
Please select
Owner Occupier - Primary Residence
Owner Occupier - Holiday Home
Tenant
Landlord
Boarder
Owner - Unoccupied House
Other
Describe other occupancy type
Type of Home
Please select
Free Standing House
Unit / Flat / Apartment
Villa / Townhouse
Terrace
Semi detached (duplex/triplex/quadplex)
Granny Flat
Nursing Home Unit
Retirement Village Unit
Other
Describe your Home
Number of Storeys
Year of Construction
Has the building ever been rewired?
Yes
No
Year Rewired
What is your home built on?
Please select
Concrete Slab
Stumps
Poles
Brick Veneer
Double Brick
Other
Construction of Floors
Please select
Concrete
Concrete and Wood
Wood
Other
Floor Construction
Construction of Walls
Please select
Double Brick
Brick Veneer
Timber/Weatherboard
Concrete
Hardiplank / Hardiflex
Corrugated Iron
Steel
Fibro
Asbestos
Stone / Sandstone
Mudbrick
Vinyl Cladding
Expanded Polystyrene (EPS) / Sandwich Panels
Other
Wall Construction
Construction of Roof
Please select
Cement Tiles
Clay Tiles
Corrugated Iron
Steel
Colourbond
Aluminium
Tin
Slate
Shingles
Fibro
Asbestos
Thatch
Other
Roof Construction
Select which security exists on all external doors
Double Cylinder Deadlocks
Single Cylinder Deadlocks
Key Card Access
None
Select which security exists on all windows
No Accessible Windows
Keyed Window Locks
Security Bars/Screens
None
Other
Other Window Security
Burglar Alarm
Please select
None
Local Alarm
Monitored Alarm to Insured's Mobile
Monitored Alarm to Monitoring Company
Interested Parties
Yes
No
Interested Party Type
Please select
Bank/Financial Institution
Landlord
Lessor
Other
Other Interested Party Type
Name of Interested Party
Insurance Options
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Which type of policy do you require?
Please select
Accidental Damage
Defined / Listed Events
Building Sum Insured (Replacement Value)
Unspecified Contents Sum Insured (Replacement Value)
Specified Contents
Specified Contents #1
Description
Sum Insured
+ Specified Contents
Specified Valuables - Contents away from home
Specified Valuables - Contents away from home #1
Description
Sum Insured
+ Specified Valuables - Contents away from home
Insurance History
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In the last 5 years have you
i) had insurance refused, cancelled, declined or special terms imposed?
Yes
No
ii) been declared bankrupt, placed in liquidation, receivership or voluntary administration?
Yes
No
iii) been convicted of or had any fines imposed for any crime involving drugs, dishonesty, arson, theft, fraud or violence against any person or property?
Yes
No
If yes to any of the above questions please provide details or phone us to discuss the matter:
In the last 5 years have you had any claims or losses for the type of risks to be insured?
Yes
No
List any claims in the last 5 years (date, description, cost and whether the claim or repairs are complete). Alternatively send us the claims history on your insurers letterhead.
Who is your current insurer?
What is your current premium?
What is your current excess?
Additional Information
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Please provide any additional information relevant to your risk, or additional covers you may require
Policy Effective Date
Policy Expiry Date
Would you like to pay monthly?
Yes
No
Promo Code