Order Number Insured Details Insured name * Policy start date * Situation of insured property * Mailing address * Occupation of tenants * Property Details Number of units * Please add correct number Number of lifts * Please add correct number Number of pools * Please add correct number Number of levels * Please add correct number Year built * Please enter year Sprinklers * No Yes - Single supply Yes - Dual supply Please select Does the property have the following facilities? Playgrounds * No Yes Please select an option Water features * No Yes Please select an option Jetties / Wharfs * No Yes Please select an option Construction of walls * Brick Concrete Fibro Timber Steel frame Other Please select an option Construction of floors * Concrete Timber Other Please select an option Construction of roof * Concrete Fibro Iron Tile Timber Other Please select an option Is any part of the property heritage listed? * No Yes Please select an option Cover required Building/s and Common Contents * Please specify limit Loss of Rent/Temporary Accommodation Additional Loss of Rent * Please specify limit Catastrophe * Please specify limit Glass Theft Liability * $10,000,000 $15,000,000 $20,000,000 $30,000,000 $40,000,000 $50,000,000 Please select Fidelity Guarantee $100,000 standard limit Office Bearers Liability * NIL $100,000 $250,000 $500,000 $1,000,000 $2,000,000 $5,000,000 $7,500,000 $10,000,000 $20,000,000 Please select an option Voluntary Workers/Personal Accident $2,000/$200,000 standard limit Government Audit Costs $25,000 standard limit Legal Expenses $50,000 standard limit Workplace, Health & Safety Breaches $100,000 standard limit Machinery Breakdown * Not required Blanket cover Please select Lot Owner's Improvements $250,000 standard limit per unit Workers compensation * No Yes As per Statutory Legislation in WA Is cover required for floating floors? * No Yes Please select Additional Questions Have you had any claims in the last 3 years? * No Yes 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? No Yes If you have selected Office Bearers Liability above you must answer this question (If yes, please attach details) Has the insurance on this risk ever been declined or had special terms imposed? * No Yes Are there any hazards/defects associated with the property? * No Yes Are the premises occupied? * No Yes Current excess * Current insurer * Your details Title * Mr. Mrs. Ms. Miss. Please select First Name * Last Name * Job Title * Company * Phone number * Email address *
