Step 1 of 8 - Your Name 12% Can I start with your name?First Name*Last Name* Nice to meet you! What type of cover are you looking for?Cover Type* Thanks for your selection! Where do you currently live?Current Address* Street Address City State Postcode Great! What are your building and contents sum insured?Great! What is your building sum insured?Building Sum insured*Great! What is your contents sum insured?Contents Sum insured*Do you require cover for any portable items outside the insured address?* Yes No Item Description & Value?*DescriptionValue Would you like your quote to include an option for Accidental Damage?*(e.g. You accidentally knock a lamp that crashes into your TV, or your laptop is damaged with spilt liquid) Yes No Can you tell us about your home?Building type* Does the land exceed 2 hectares?* Yes No Contact our office as a Farm Pack quotation will be requiredIs business conducted from home?* Yes No Details*Occupancy typeSelect oneOwner OccupiedRent/LeaseHoliday HomeYear the building was constructed?Number of BedroomsNumber of BathroomsWhat is the wall constructed of?Select oneDouble BrickBrick vennerAluminiumFibro/Asbestoshardiplank/HardiflexConcreteSteelStoneVinyl CladdingWeatherboard/WoodSandwich FoamMud BrickStrawOtherWhat is the roof constructed of?Select oneTileTin/ Steel / ColourbondIron (Corrugated)AluminiumFibro/AsbestosConcreteSlateThatchTimberQuality of the buildingSelect oneStandard qualityAbove AverageTop of the rangeHow many storeys in the building?*Select one123 or moreSplit levels are considered separate levels.Will the property ever be unoccupied for more than 100 days?* Yes No Is the property poorly maintained or in poor condition?* Yes No Is the property under construction/renovation?* Yes No Is the property heritage listed?* Yes No Can you tell us about your home security?Type of security on external doors* What type of window security do you have?* Type of alarm* Lets talk about your claims history for the past 3 yearsNumber of claims in last three years*Select one0123456789+When did you make your most recent claim?Select oneNever201920182017201620152014Have you been declined insurance?* Yes No Have you had a claim declined?* Yes No Have you had any criminal convictions for fraud or arson?* Yes No Almost done! May I grab a few quick details?Are you currently insured?* Yes No Who is the current insurerCurrent policy expiry date? DD slash MM slash YYYY Current policy excessEmail Address* Phone*Date of birth of the oldest insured*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
