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First Name:
Last Name:
Email:
Phone:
Insured or Company Name:
Date of Birth:
Start Date:
Insured Property Address:
Postal Address:
What material are the external walls built with?
Roof Type:
Additional Security (alarms, deadbolts, window locks etc):
What year was the property built?:
Is there a pool/spa/sauna?:
Yes
No
Building Sum Insured (excluding land):
Contents Sum Insured (any items over 10k may need specifying):
Excess:
Please Select
$300
$500
$1000
Is the property managed?
Yes
No
Is the building a strata property?
Yes
No
Theft by tenant cover?
Yes
No
Loss of rent cover?
Yes
No
Any claims in the last 3 years?
Yes
No
Details of any claims within the last 3 years (if any):
Interested Parties (mortgagee):
Do you provide any extra services/activities as part of your guests stay at the premises: