1. Property used for
Residential Rental AccommodationCommercial Rental Accommodation
2. There is a written lease in place, and a condition report is completed annually. Yes
Property Manager's Name
Real Estate Agency Office
Your Email
Contact Phone Number
Surname
Given Name(s)
Address (Please provide postal address, if it is different to street address)
State NSWQLDSATASVICWAACTNT
Postcode
Email
Work Phone Number
Date of Birth
Company Name (if applicable)
ABN(if applicable)
Preferred contact method: EmailPhoneMobileWorkSMS
Please provide details of the property you are insuring:
Street Address
Weekly Rent Amount
Please specify mortgage provider:
(to be noted as an interested party on the Certificate of Insurance)
Property Type ApartmentHouseTownhouse
Do you require a quote for your building insurance? YesNo
Total Building Sum Insured $
Property walls BrickDouble brickWeather boardOther
Roof TilesIronColorbondOther
Locks on windows and doors YesNo
Alarm LocalMonitoredNo Alarm
Year of build
Pet Cover YesNo
Insurance Start Date:(cannot be backdated, or more than 30 days in advance)
Has anyone to be named insured had a claim refused or declined for fraud or dishonesty ? YesNo
In the last 5 years, has anyone to be named insured been declared bankrupt, or entered into a part 9 debt agreement whether voluntary or not, or had any other default judgment registered against them ? YesNo
In the last 5 years, has anyone to be named insured had any criminal convictions ? YesNo
You will receive a Certificate of Insurance and Invoice which states our payment details, in order for you to deposit the premium amount.If being completed by a Property Manager, the Property Manager has authorisation from the owner/s to arrange this Insurance Policy on his/her behalf for the above rental property.
I have read and understood the policy terms and conditions
Authorised person’s full name:
Authorised person’s signature:
Digital signature or typed name is acceptable for forms submitted digitally
Date: