Landlords Residential Insurance Online Quote Form

Please complete the following information and submit this form to obtain a landlord insurance quotation for your residential tenanted property. Please click on the following if you require a quotation for a commercial tenanted property.

All information you provide must be correct, true, and accurate as incorrect or misleading information may alter our quote and jeopardise cover if you proceed with a policy.

Please refer to the CGIB Financial Services Guide, Privacy Statement, General Advice Warning and Duty of Disclosure before completing this form.

name of Insured/s*
Property Address*		City/Town*	Post Code*
Postal Address*		City/Town*	Post Code*
Occupied By*
Date of Birth*	/ / (Date of birth of oldest insured)	Retired?

Construction of Walls
Construction of Floors
Construction of Roof
Does the building have cladding?

Building type
Age of Building
Connected to Town Water?
Is the home Heritage Listed?
Security?	Deadlocks on all external doors	Security Intercom	Window grills/bars on all windows
	24 hr security person/concierge	Fixed Safe	2 floors above ground
	Key window locks on all windows	Back to base alarm	Local alarm
	Security card/security pad access to floor
	Security card/security pad access to floor
size of the home? (sqm)
Condition of Home?
Is the House:	Re-wired Re-plumbed
Is your property managed by a professional property agent?

type Of Cover
Building Sum Insured
Contents Sum Insured
Annual Rent
Rent Default Required?
Malicious Damage by Tenant Required?
Domestic Workers Compensation Cover	(Available in NSW, ACT, TAS and WA)

Is the property Insured?*
If "YES", please provide the date your existing policy expires* / /
Please provide the name of the Insurer*
Have you ever suffered any losses or claims?
Have you ever had any insurance cancelled or declined or special terms imposed?
Have you ever been charged or convicted of any criminal offence or declared bankrupt?
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?

Landlords Residential Insurance Online Quote Form

INSURED'S - Details

PREMISES - Details

INSURANCE – Details

PREVIOUS INSURANCE - Details - MUST COMPLETE ALL QUESTIONS

CONTACT – Details

What material is the cladding?
State the percentage of the building in which cladding is used

First name*
Surname*
Phone No*
Fax No
Email Address*
How did you find us*
If other, please provide details