Commercial Property Owners Quote Form
Insured Name
*
Contact name
*
Email
*
Retype email
*
Telephone Number:
Risk Address of Property to be insured
*
Suburb
*
State
Please Select
NSW
QLD
VIC
WA
SA
NT
TAS
Post Code
*
Prefer Monthly or Annual
Please Select
Annual
Monthly
Building Construction Walls
Please Select
Double Brick
Brick Veneer
Besa Block
Tilt Slab
Fibro
Timber
Steel
Colourbond
Other (please provide more info)
Mixed (please provide more info)
Does Building contain EPS - Sandwich Foam Panel construction (Includes Structural or Non-structural) if so what %
Please Select
YES
Less than 15%
Less than 20%
30% to 50%
Greater than 50%
NO - BUILDING HAS NO EPS
Buildings Frame
Please Select
Brick
Besa Block
Tilt Slab
Timber
Steel
Other (please provide more info)
Mixed (please provide more info)
Buildings Roof
Please Select
Tile
Iron
Concrete
Timber
Abestos
Colourbond
Fibro
Other (please provide more info)
Mixed (please provide more info)
Buildings Floor/s
Please Select
Concrete
Timber
Tiled
Other (please provide more info)
Mixed (please provide more info)
Approximate year Built
Number Of Stories/levels
Please list ALL tenants and their occupations & approximate percentage that they occupy of the building as this is required to calculate your insurance premiums
List of Tenants who occupy your building
*
Fire Protection
Fire Alarm back to base
Hard Wired Smoke alarm
Battery smoke alarms
Fire extinguishers
Fire hose reel
None-No fire protection
Security Protection
Deadlocks all external doors
Key operated window locks all windows
Bars or Grills all windows
Back base monitored alarm
Local alarm
Normal key locks only
No security
Security Patrol
Any Hazardous Goods stored at property to be insured
Please Select
YES
NO
Please provide some details of Sums insured or Cover required as this is required to calculate your insurance premiums
BUILDING SUM INSURED
CONTENTS SUM INSURED
ANNUAL LOSS OF RENT SUM INSURED
PROPERTY OWNERS LIABILITY
Please Select
$5,000,000
$10,000,000
$20,000,000
ANNUAL RENTAL
*
Are You Owner & Occupier of Building
Please Select
NO - Property Owner Only
YES - Owner & Occupier
YES - Occupy along with other tenants
GLASS COVER
Please Select
YES - Internal & External
YES - External Only
NO - (No glass cover required)
Are tenants responsible to insure Glass
Please Select
YES
NO
MACHINERY BREAKDOWN
Please Select
YES
NO
IF YES TO MACHINERY BREAKDOWN PLEASE LIST ITEMS, SIZE OF MOTOR & REPLACEMENT SUM INSURED
HISTORY DETAILS ( if you answer yes to any of the below questions please provide further information in free text box below)
Has the insured or any Directors had any claims in the last 5 years
*
Please Select
YES
NO
Has the insured or any Directors had any criminal convictions in the last 10 years
*
Please Select
YES
NO
Has the insured or any Directors had a claim refused, insurance declined or any special conditions imposed in the last 5 years
*
Please Select
YES
NO
Is the insured or any Directors aware of any circumstance that may lead to a claim
*
Please Select
YES
NO
CURRENT INSURER
Expiry Date of current Insurance or date to start cover
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
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2016
2015
2014
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2012
2011
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1927
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1922
1921
1920
Year
ANY OTHER INFORMATION PLEASE USE THIS TEXT BOX
ANY OTHER INSURANCE YOU WANT QUOTES ON SUCH AS BUSINESS,MOTOR, LANDLORDS, HOME & CONTENTS, WORKERS COMPENSATION PLEASE USE THIS TEXT BOX
DUTY OF DISCLOSURE ( Please ensure all details are correct as answers on this form will be used to obtain quote and or cover and if incorrect or not disclosed information this could affect a claim being paid)
Submit
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