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Home and contents insurance

Please complete this form so we can provide you with the most accurate quote possible.

Date you wish policy to commence
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Cover
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Name of insured
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Date of birth
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Situation address
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Postal address
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Contact number
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Email
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Mortgagee
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Occupancy details
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If landlord: (select all that apply)

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Please enter loss of rent amount
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Please enter weekly rental amount
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Rental length
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Property size (acres or house block)
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Construction

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Please provide details
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Roof
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Heritage listed?
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Year built
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Re-wired or re-plumbed?
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Please provide year work was completed
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Security

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Building sum insured
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Contents sum insured
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Specified contents sum insured
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Specified valuables sum insured
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Unspecified valuables sum insured
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Amount of cover required
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Accidental damage

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Preferred excess
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In the last five years has the insured:

Had insurance cancelled, declined or special terms imposed?
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Been charged or convicted of a criminal offence?
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Been declared bankrupt or placed in receivership?
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Made any claims?
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Please provide full details:
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Preferred contact method

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Current premium per
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Additional Comments
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Spam Check(*)
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Please type the two words into the box above and then select the 'SUBMIT' button.