Home and Contents Quote

Insured Details
Insured name:
Email Address:
Contact No:
Date of birth of the oldest insured (dd/mm/yyyy):

Cover Details
Level of Cover:
Please provide the level of cover you are after?:
Current Excess:
Current Insurer:

Building Details/Occupancy & Location
Exact Address of situation
Approximate Year built
Postcode
Suburb/Town
State
Occupied by
Building type
Wall Construction
Foundation Construction
Roof Construction
Is your home located on a site exceeding 20,000 square metres?

Claim
How many total claims (including thefts/burglaries) on building/contents have you, or any of the occupants made in the last five years?
How many burglaries or thefts have you, or any of the occupants experienced at this address in the last five years?

Claims Details
Description of claim
Year		Amount

Please enter RMA Member

Building
Sum insured

Contents
Sum Insured

Additional Contents
What is the highest value of any single item, pair or set that you wish to specify?
Details
What is the highest value of any single jewelery item that you wish to specify?
Details

Optional Cover
Flood Cover

Security details
Deadlocks on all external doors?
Key operated window locks or grilles on all external windows?
Alarm type

Underwriting information
Have you or anyone permanently residing with you, been convicted of arson, theft, fraud or violence against any person or property in the last 10 years?
Have you or anyone permanently residing with you, been convicted of any crime involving drugs, dishonesty, arson, theft, fraud or violence against any person or property in the last 5 years ?
During the last 3 years, has any insurer refused to insure your home and/or contents? Is the building either:
1. Being let or rented on a commercial basis eg. hotels/hostel/motels, guest house, boarding house? Or
2. Poorly constructed, badly maintained or subject to a demolition order?

Additional Information
Is the building National Trust classified or heritage listed?
Is the building being shared by more than 3 unrelated persons?
Is any part of the risk address used for any business, trade or profession, other than a home office, or is the building located on a farm or hobby farm?
Has or will the building be unoccupied for any period in excess of 60 consecutive days?

Home Contents in Transit Insurance
Are you moving house shortly or as a result of this quotation?
If you are moving premises either with a professional carrier or yourself you can purchase Home Contents in Transit Insurance to protect your assets whilst being moved. Please provide some additional details below to allow us to provide a quote and explaination of cover

Information
Move Date:
Professional Removalist or Own Move?
Including Motor Vehicles/Motor Bikes/Caravans/Boats?
Including Live Plants?
Including Works of Art, Antiques etc?
Movement
Within Australia or Overseas:
Please provide details of from and to
From Postcode or Town
To Postcode or Town
Sum Insured details
Home Contents:
Antiques/Paintings:
Cars/Boats etc:
Storage
Is storage required as part of the move?

Months
Value Stored
Postcode of Storage


Note that all fields are mandatory and the form will not submit with empty selections.