Landlords Insurance Questionaire Step 1 of 6 16% Underwriting Acceptance CriteriaHas the insured had a claim refused, insurance declined, or special conditions imposed on a policy of insurance in the last 5 years?* Yes No If yes, please provide details Has the insured, or anyone permanently residing with insured, 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, within the last 10 years?* Yes No If yes, please provide details InsuredName of insured party?* First name Middle Name Last Name Date of birth of oldest insured party?* Day Month Year Current insurer? ClaimsHave the insured parties made any residential related claims as a landlord within the past 5 years?* Yes No Claim informationPlease tell us about all the claims made during this period:Acceptance CriteriaIs the property:a) Used for business purposes other than home office or surgery?* Yes No b) under construction, reconstruction or renovation?* Yes No c) in poor condition or poorly maintained?* Yes No e) under any heritage listing/ National Trust listing or order?* Yes No f) used as a hostel, bed and breakfast, guest house, boarding house or student accommodation?* Yes No g) currently unoccupied or expected to be unoccupied for more than 90 continuous days during the period of cover?* Yes No If yes, please provide details h) Will any part of the property be used for farming?* Yes No If yes, please provide details i) Has the land where the building or contents are situated been flooded or inundated by water more than once in the last 10 years?* Yes No If yes, please provide details j) Are you a charity registered with any regulatory, government or community organisation providing community, public or social housing accommodation services? Or do you lease, or intend to lease property to businesses or organisations that provide community, public or social housing accommodation services?* Yes No k) Are you a self-managed superannuation fund (SMSF), the trustee of a SMSF, or a property trust?* Yes No CoverageIs the block of land larger than 20,000sqm?* Yes No Occupancy type*Rented to tenants (long term basis)Rented to tenants (short term basis)Leased on a short term tenancy basis?Owner occupied and rented to tenants (short term basis)Weekender/ holiday home and rented to tenants (short term basis)Building type*Free standing houseTownhouseTerraceApartment/ Flat/ UnitSemi-DetachedDuplex/ Triplex/ QuadplexGranny flatBlock of Flats/ Units/ ApartmentsIf apartment/ flat/ unit, thenYesNois the building subject to a strata plan?If apartment/ flat/ unit, thenWhat floor are you located on? Type of cover required?*Buildings and contents insuranceBuildings ONLY insuranceContents ONLY insuranceHow many unrelated persons are living in the building?*Is the property managed by a professional property agent?* Yes No Do you have a current rental agreement or periodic tenancy in place?* Yes No Is the property part of a Strata Title?* Yes No Do you require Strata Title Mortgage Protection?* Yes No Do you want cover for theft by a tenant?* Yes No Do you want cover for rent default?** You must have a rental agreement or periodic tenancy agreement in place to be eligible for cover for rent default. Yes No Do you want cover for loss of rent?** To the maximum of your annual rental income. Yes No Annual rental income BuildingsHome address* Street Address Address Line 2 City State Post Code AustraliaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Construction DetailsWallsWhat is the main building material that the walls are constructed from?AluminiumBrick veneerConcreteDouble brickFibro/ asbestosHardiplank/ HardiplexMud brickSandwich foam/ EPSSteelStoneStrawVinyl claddingWeatherboard/ woodOtherif other, what materials are the walls constructed of? if other, what materials are the walls constructed of?RoofWhat is the main building material that the roof is constructed from?AluminiumConcreteFibro/ asbestosIron (Corrugated)SlateThatchTin/ steel/ colourbondTilesTimberAge or year built How old is the building or what year was it constructed in?Number of levels123+QualityStandard qualityAbove average qualityTop of the rangeBuilding replacement value? Estimated replacement valueContents replacement value? Estimated replacement valueAre there any swimming pools &/or spas on the property for which you are liable?* Yes No Are there any lifts, escalators or hoists for which you are liable?* Yes No SecurityWhat best describes the security on the property's externally accessible doors?*NoneDeadlocks onlyKey card accessDeadlocks and key card accessWhat best describes the security on the property's externally accessible windows?*NoneNo accessible windowsSecurity bars/ security screens onlyKey operated locks onlySecurity bars/ screens AND key operated locksAlarm security?*NoneMonitored burglar alarmUnmonitored burglar alarm Contents Sum InsuredContents sum insuredExcluding Special ContentsProvide details of Special Contents (if any)Special Contents sum insuredWould you like more information about Specified Valuables cover?NOTE: Noting Specified Valuables is easy and cost-effective. If you want to add listed Specified Valuables, please tick this box and we will email you to gather the necessary information. Yes, please contact me No thank you Interested PartiesWill there be any interested parties listed on the policy?* No Yes Please list any interested parties to this property Include details of mortgage holders.Paying monthly?*Monthly payments are available at no additional cost Yes please No thanks Preferred email address for quote?* Duty of disclosureYour duty of disclosure*Before you enter into an insurance contract, you have a duty of disclosure under the Insurance Contracts Act 1984. If we ask you questions that are relevant to our decision to insure you and on what terms, you must tell us anything that you know and that a reasonable person in the circumstances would include in answering the questions. You have this duty until we agree to insure you. If you do not tell us something If you do not tell us anything you are required to tell us, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both. If your failure to tell us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed. I have read and I understand my duty of disclosure. CommentsThis field is for validation purposes and should be left unchanged.