"*" indicates required fields Step 1 of 4 25% Insured DetailsFull Legal Name* First Last Address* Street Address Suburb Postal Code Date of Birth* DD slash MM slash YYYY Contact Telephone*Email Address* Policy CoverType of Cover* Defined Event Accidental Damage Commencement Date* DD slash MM slash YYYY Sum InsuredBuilding ($)*Contents ($)*Specified Contents ($)(eg contents with high replacement value such as Artwork, Antiques or Collections)Specified Valuables ($)(eg valuables with high replacement value that are typically taken outside of the home, such as Jewellery, Watches or Electronic Devices) Insured Property DetailsInsured Property Address* Street Address Suburb Postal Code Year Built*Is property owner occupied?*SelectYesNoIs property currently unoccupied or will it be unoccupied for over 90 days?*SelectYesNoDwelling Type*SelectFree-standing houseTownhouseHoliday Home / Short termFlat / ApartmentNumber of Levels*Number of Bedrooms*Number of Bathrooms*Construction* Brick Brick Veneer Timber Concrete Other Please provide details*Roof* Tiled Tin/Iron Slate Other Please provide details*Security* Window locks Dead locks on external doors Bar or grills on windows Alarm Monitored Local Is the property used for business?*SelectYesNoWhat type of business?*Other Interest Parties - MortgageeName Insurance History - During the last 5 years has the applicant had any:Made a claim to insurance company?*SelectYesNoApplication for insurance rejected?*SelectYesNoA policy cancelled by any insurance company*SelectYesNoSpecial conditions set on your policy?*SelectYesNoRenewal of any insurance policy not offered?*SelectYesNoIncreased excess imposed on your policy?*SelectYesNoIf you have answers YES to any of the above questions, please provide additional information:*Personal History - Has the applicant ever:Been charged or convicted of a criminal offence?*SelectYesNoBeen declared bankrupt?*SelectYesNoWhat is 10 + 8 ?*Spam SecurityEmailThis field is for validation purposes and should be left unchanged. Δ
