Landlord Quote

Your Details

Full name: (incl Title) *

Contact telephone number: *

Date of Birth: *

Email address: *

Contacting You

Preferred contact method: *

Preferred contact time: *

How did you hear about us? *

Situation Details

Situation address:

State:

Postcode:

Duty of Disclosure

Ever had any insurance cancelled or declined or special terms imposed? *

YesNo

Ever been charged or convicted of any criminal offence or declared bankrupt? *

YesNo

Insurance Requirements

Buildings sum insured:

Contents sum insured:

Loss of Rent sum insured:

Do you require Rent Default & Tenant Damage?

YesNo

Who lives at your home?

Age of the home:

Has the property been rewired or replumbed? *

YesNo

Heritage listed: *

YesNo

What are the outside walls constructed of?

What is the main roofing material used?

Security of the property:

Any other specific cover required. Please detail

Claims Experience

Please provide full details of any claims made and/or losses suffered under previous Landlord Insurance during the past 5 years (whether or not a claim was made):

General Questions

Please use this box to provide any further information that may be relevant to your Landlord Insurance policy :

Current Landlord Insurance provider:

Renewal date of existing insurance/date cover to start (as applicable):

Current Landlord Insurance premium:

Are you an existing customer?

YesNo


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