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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: