Proposal / Quotation Request Form Landlords Proposal / Quotation Request Form If you are human, leave this field blank. Details Applicant Name * Owner's Date of Birth (DOB) * Postal Address * Street * Suburb Postcode State * QLD NSW VIC SA TAS NT ACT Phone Business Mobile Email Address: Period of Insurance Effective Date from * Expiry Date to 4pm on * We cannot backdate the commencement date of your policy. Details of Property 1. Address of the property and/or contents to be insured Unit No. * Is the property above the Ground Floor? * Yes No Level No. * Street * Suburb * State * QLD NSW VIC SA TAS NT ACT Postcode * 2. Construction Walls * Roof * Does the building have National Trust classification? Yes No Unknown Building Description Town House Unit Other Year your unit was constructed * Building/Body Corporate Name * Does the property have a burglar alarm? No Alarm Local alarm Monitored alarm (back to base) Does the property have key operated locks, and/or bars, and/or grills on all accessible windows? Yes No Does the property have deadlocks and/or security doors on all external doors? Yes No Is the property managed by a licensed managing agent? Yes No Is the property part of the Body Corporate or Strata Scheme? Yes No If Yes what is the Body Corporate Manager’s Company name? * Contents Contents Sum Insured Required * $30,000 $40,000 $50,000 $60,000 $70,000 Other Accidents,Claims and Personal Details During the last 5 years, have you or anyone permanently residing with you had any thefts, burglaries, fires or accidents involving damage to property or contents or injuries to any person (whether or not a claim was made)? Yes No Have you or anyone else to be insured under this insurance, been convicted of or had any fines or penalties imposed for any crime involving drugs, dishonesty, arson, theft, fraud or violence against any person or property during that last 10 years*? Yes No During the last 3 years has any insurer refused to insure your home and/or contents or any other property owned by you*? Yes No Have you been declared bankrupt and not been discharged for at least one year*? Yes No Is there currently a tenant in place? Yes No Is the property let for holiday bookings*? Yes No or Is the lease agreement in any form other than a written agreement? Yes No If Yes, what is the weekly Rent amount? * Are the bond monies you hold less than the equivalent of 4 weeks rent? Yes No Was the initial rental period for less than 6 months? Yes No If Yes, to any of the above please provide details: Declaration This declaration applies to all the insurance you are applying for in the proposal I declare that I have: Read and understood the policy wording and Product Disclosure statement; Yes Read and understood the Financial Services Guide; Yes Read the information concerning the Duty of Disclosure and other important notices; Yes Yes I agree that I have truthfully provided the required information in accordance with the Duty of Disclosure and understand that if I have not complied with my duty of disclosure that my claim may not be met. If anything happens during the period of insurance which alters any of the information I have provided I will promptly inform my insurers. Yes Either completed this form personally or, if it has been completed by someone else I have checked that all the questions have been fully and accurately answered Yes 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 bodycorporatebrokers.com.au or contact us for a copy.
