Proposal / Quotation Request Form

Landlords Proposal / Quotation Request Form


Period of Insurance

We cannot backdate the commencement date of your policy.

Details of Property

1. Address of the property and/or contents to be insured
2. Construction


Accidents,Claims and Personal Details



This declaration applies to all the insurance you are applying for in the proposal

I declare that I have:

I realise that if I have not complied with my duty of disclosure my claim may not be met.

Note: please be aware that our ability to check and verify information does not relieve you of your obligation to disclose the truth to us.

Privacy: We use the information you provide to arrange insurance. We only give your information to people involved in providing insurance for related services. We do not trade, rent or sell your information. You can check the information we hold about you at any time. For more information about our privacy policy. refer to our website or contact us for a copy.