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application please call us on 1300 558 158
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Yes
No
Are you an Insurance Broker?
In what capacity are you applying for this insurance ?
Property Owner Only
Owner Occupier
Tenant Only
Intrested Party
Named Insured
In what capacity is the landlord to be noted?
Occupation
Licensed Brothels
Location of Business
Street Number/Name
Suburb
State
NSW
ACT
Vic
Qld
SA
WA
TAS
NT
O/S
Postcode
Building Construction Details
Year Built
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Yes
No
Rewired
When was the building rewired?
Replumbed
When was the building replumbed?
Heritage Listed or Overlay
Walls
Brick
Wood
Iron
Floor
Concrete
Wood
Roof
Tiled
Iron
Fibro
Number of Stories
1
2
3
4
5
Yes
No
Sprinklers Installed
Hose Reels
Fire Alarm
Thermal/Smoke Detectors
Fire Extinguishers
Service/Maintenance Agreements in Place
Insurance Requirements
Building Sum Insured Required
$
Removal of Debris Cover Required
$
Public & Products Liability
Annual Revenue/Turnover
$
Number of Employees
Estimated Wages
$
Annual Rental Income
$
Limit of Liability Required
Nil
$10M
$20M
Yes
No
Do You Require Business Interruption Insurance ?
Sum Insured
$
Indemnity Period
6 Months
12 Months
18 Months
Do you require cover for Additional Increased Cost of Working?
Level of Cover Required
$
Do you require cover for Claims Preparation Costs?
Level of Cover Required
$
Do you require cover for Outstanding Accounts Receivable?
Level of Cover Required
$
Do you Require Cover for Loss of Rent?
Annual Rental Income to Insure
$
Yes
No
Do you require Contents Cover?
Contents Sum Insured Required
$
Stock Sum Insured Required
$
Do you want to cover Theft of Contents or Stock?
Contents Sum Insured Required
$
Stock Sum Insured Required
$
Are the premises fitted with an Alarm?
Type of Alarm
Monitored
Local
Dialler
Are there Watchman Patrols?
Are there Deadlocks fitted on all external doors ?
Are there Window Locks/Bars or Grills Fitted?
Theft without forcible entry
$
Do you want cover for Lost/Stolen Money ?
Do You have ATM Facilities?
Blanket Cover Amount Required?
$2,500
$5,000
$10,000
$15,000
$20,000
$30,000
Do you want cover for Glass Breakages ?
Do you need to provide Cover for an Unrelated Landlord?
Name of Landlord
Building Sum Insured Required
$
Annual Rental:
$
Does the Landlord require cover for Loss of Rent?
Do you Require Cover for any of the following?
Yes
No
Machinery Breakdown
General Property
Employment Practices
Professional Liability
Electronic Equipment Cover
Employee Dishonesty
Transit
Statutory Liability
 
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