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Insured Details
Insured
Due Date
Situation of Insured Property
Mailing Address
Occupation of Tenants

Property Details
No. of Units
No. of Levels
No. of Lifts
Year Built
No. of Pools
Sprinklers

Does the property have the following facilities?
Playgrounds Yes No
Water Features Yes No
Jetties/Wharfs Yes No

Construction of Walls
Construction of Floors
Construction of Roof

Is any part of the building heritage listed? Yes No

Cover Required
Building/s and Common Contents

Additional Loss of Rent
(Note: 15% automatically included)
Catastrophe Cover
Liability
 

Fidelity Guarantee ($50,000 standard limit) Yes No
Office Bearers Liability  

Voluntary Workers/Personal Accident ($100,000/$1,000 standard limit) Yes No
Machinery Breakdown (if yes, please provide details below) Yes No

Machinery Breakdown details:

 
Workers Compensation
(As per Statutory Legislation NSW)		 Yes No

Duty of Disclosure Details
Have you had any claims in the last 3 years?
(If yes, please provide details below)

 Yes No
Has the insurance on this risk ever been declined or had special terms imposed?
(If yes, please provide details below)

 Yes No
Are the premises occupied?

 Yes No
Are there any hazards/defects associated with the property? (If yes, please provide details below)

 Yes No

Duty of Disclosure
details
Current Insurer
Current Excess

Your Details
Title
First Name
Last Name
Job Title
Company
Telephone
Facsimile
Mobile
E-mail

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