(08) 8332 0281 insurance@ssaains.com.au

Home and Contents/Landlord Insurance Quote


Insured details applicant 1

First name*

Surname*

Date of Birth*

Home phone

Work phone

Mobile phone

Email address*

Over 55 & Retired?*
YesNo

Preferred Method of Contact?*
EmailPhoneFax

SSAA membership number (if applicable)

Insured details applicant 2

First name

Surname

Date of birth

Policy Cover

Current insurer*

Expiry date*

Current excess

Current premium (optional)

Occupancy?*
Owner OccupiedApplicant is tenantApplicant is landlordHoliday homeUnoccupied

Type of Cover?*
HouseholdLandlords

Landlords

Loss of rent (weekly)

Rent default and theft by tenant?
YesNo

Is the property managed by a licensed property agent?
YesNo

Insured Property Details

Property Address

Address*

Suburb/town*

State*

Postcode*

Postal Address

Postal address same as property address

Address

Suburb/town

State

Postcode

Other

Dwelling Type*

If Other, please specify Dwelling Type

Construction of building*

If Other, please specify Construction Type

Roof*

If Other, please specify Roof Type

Is the building…*

Year Built*

Sum insured

Part 1

Building (replacement value*)

Contents (replacement value*)

Part 2

Specified valuables (covered when outside the home property – items exceeding $10,000)

 
Description
Value

1.

2.

3.

4.

5.

6.

7.

Security details

Deadlocks on all external doors?*
YesNo

Keyed window locks on all windows?*
YesNo

Back to base alarm?*
YesNo

Local alarm system?*
YesNo

Is the property used for business?*
YesNo

If Yes, what type of business?

Is the property attached to mains water?*
YesNo

Safe?*
YesNo

Gun safe?*
YesNo

Bars or grills on all accessible windows?*
YesNo

Is the property on more than 4 acres?*
YesNo

Will the property be unoccupied for more than 60 days in the next 12 months?*
YesNo

Insurance history

Has any applicant been declared bankrupt and not discharged for at least one year?*
YesNo

If Yes, please supply details

During the last 5 years has any applicant had any type of loss or damage (whether claimed or not)?*
YesNo

If Yes, please supply details

Is the property to be insured attributable to flood?*
YesNo

During the past 5 years has any applicant had any:

(a) Application for insurance rejected?*
YesNo

If Yes, please supply details

(b) Policy cancelled by an insurance company?*
YesNo

If Yes, please supply details

(c) Special conditions set for your policy?*
YesNo

If Yes, please supply details

(d) Renewal of insurance policy not offered?
YesNo

If Yes, please supply details

(e) Increase excess imposed on your policy?*
YesNo

If Yes, please supply details

During the last 10 years has any applicant had any criminal conviction relating to drugs, dishonesty, arson, theft, fraud or violence against any person or property?*
YesNo

If Yes, please supply details

I have read the Duty of Disclosure. (View)