About Us About Us eQuote Services Claims Training Proposal forms Forms
Residential Strata Insurance
Commercial Strata Insurance
Residential Landlord Insurance
Commercial Landlord Insurance
Residental Strata Title Mortgagee Protection Insurance
Commercial Strata Title Mortgagee Protection Insurance Protection Insurance
 
 
Insured Details
Insured
Due Date
Situation of
Insured Property
Mailing Address

Property Details
No. of Units
No. of Levels
No. of Lifts
Year Built
No. of Pools
Sprinklers

Does the property have the following facilities?
Playgrounds Yes No
Water Features Yes No
Jetties/Wharfs Yes No

Construction of Walls
Construction of Floors
Construction of Roof

Is any part of the building heritage listed? Yes No

Cover Required
Building/s and Common Contents
(please specify limit)
Additional Loss of Rent
(Please specifiy limit - Note: 15% automatically provided)
Additional Catastrophe Cover
(Please specifiy limit - Note: 15% automatically provided)
Glass

 Automatically Included
Theft

 Automatically Included
Liability
(Please specify limit)
 

Fidelity Guarantee ($100,000 standard limit)

 Automatically Included
Office Bearers Liability
(Please specify limit)

Voluntary Workers/Personal Accident ($2,000/$200,000 standard limit)

 Automatically Included
Government Audit Costs ($25,000 standard limit)

 Automatically Included
Legal Expenses ($50,000 standard limit)

 Automatically Included
Workplace, Health & Saftey Breaches ($100,000 standard limit)

 Automatically Included
Machinery Breakdown (Please specify limit)

Machinery Breakdown details:

 
Lot Owner's Improvements ($250,000 standard limit per unit)

 Automatically Included
Workers Compensation
(As per Statutory Legislation in WA)		 Yes No

Duty of Disclosure Details
Have you had any claims in the last 3 years?
(If yes, please provide details below)

 Yes No
If you have selected Office Bearers Liability above you must answer this question - Are you aware of any claims made or circumstances which may result in claims being made against a Committee Member or their predecessors in their capacity as members of the committee or governing body?
(If yes, please attach details)

Yes No
Has the insurance on this risk ever been declined or had special terms imposed?
(If yes, please provide details below)

 Yes No
Are the premises occupied?

 Yes No
Is any portion of the building occupied for commercial purposes?
(If yes, please provide details below)
Yes No
Are there any hazards/defects associated with the property? (If yes, please provide details below)

 Yes No

Duty of Disclosure Details
Current Insurer
Current Excess

Your Details
Title
First Name
Last Name
Job Title
Company
Telephone
Facsimile
Mobile
E-mail

If you would like to print this form, before submitting, please click here.

 
 
   
   
   
   

 
Impress design Privacy Terms and Conditions
Copyright