Home or Landlords Insurance Quotation Request

  Yes No
  Monthly debit     Annual payment
 
  Yes No
  Yes No

Location of risk

  Yes No

Building & Construction

Approximate if unknown
Approximate if unknown

Property Occupancy / Details

  Yes   No   Not recently purchased
  Yes   No
  Acreage   Town Block
  Yes   No
  Yes   No
  Yes   No
  Yes   No
  Yes   No
  Yes   No

Sums Insured

  This amount should reflect the amount it would cost to rebuild your home.
  This amount should reflect the amount it would cost to replace all your contents. If rental property, provide the replacement value of contents provided for tenants use including carpets, curtains and internal blinds.
  Yes   No
 
  Rent default cover   Theft by tenant cover

Security

 
24 hour security person / concierge
Back to base alarm
Double keyed deadlocks on all external doors
Fixed safe
Keyed window locks on all windows
Local alarm
Securitel / Landline
Security card / security pad access to floor
Security intercom
Unit at least two floors above ground
Window grills / bars on all windows
None of the above

Insurance History

  Yes   No
  Yes   No
  Yes   No
  Yes   No
  Yes   No
  Yes   No
  Yes   No

Your Duty of Disclosure

In accordance with the provisions of the Insurance Contracts Act 1984 (Section 22), we are required to advise you of your responsibilities in relation to the disclosure of relevant information.

Before you enter into a Contract of General insurance with an Insurer, you have a duty under the Insurance Contracts Act 1984 to disclose to the Insurers every matter that you know, or could reasonably expect to know, is relevant to the Insurer’s decision whether to accept the risk of insurance and, if so, on what terms. You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate a Contract of General Insurance. Your duty however does not require disclose of matters:
a) that diminishes the risk to be undertaken by the Insurer;
b) that is common knowledge;
c) that your Insurer knows or, in the ordinary course of business, ought to know;
d) as to which the compliance with our duty is waived by the Insurer.

Non-Disclosure

If you fail to comply with your Duty of Disclosure, the Insurer may be entitled to reduce the liability under the Contract in respect of a claim or may cancel the Contract.

If your non-disclosure is fraudulent, the Insurer may also have the option of avoiding the Contract from its beginning.

Declaration

I declare that the contents of this form are true and that I have not omitted any material information. If this information differs before the contract of insurance is concluded, I will tell the Insurers.

  I have read and agree to the Duty of Disclosure.