HOUSE / HOUSE AND CONTENTS QUOTE
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HOUSE / HOUSE AND CONTENTS QUOTE

INSURED CONTACT DETAILS

Physical Address

Postal Address different
(checkbox if different from physical address)

Postal Address

Disclosure Questions

Have you been declined insurance in the past three years?
Have you had any criminal convictions in the past five years?
ARE THERE OTHER REGISTERED PROPRIETORS?
(checkbox if there are other registered proprieters)

REGISTERED PROPRIETOR CONTACT DETAILS

Registered Owner Address different
(checkbox if different from physical address)
Have you been declined insurance in the past three years?
Have you had any criminal convictions in the past five years?
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PROPERTY DETAILS

Select type of Property

Property Address

Is this property part of an Owners Corporation / Strata?
Exterior building material (brick/ weatherboard etc)?
please provide details
Built on
please provide details
Roof material (colourbond / tiles etc)
please provide details
Home quality
Details of security to home
Alarm details

OCCUPANCY TYPE

Select Occupancy Type

IS THE PROPERTY

used for business purposes other than home office?
currently, or scheduled to start construction or renovation during this period of cover?
in poor condition or poorly maintained?
currently unoccupied or expected to be unoccupied for more than 90 consecutive days during this period of cover?
under any heritage listing / National Trust listing or order?
used as a hostel, hotel, serviced apartment, boarding house, guest house?
used for community housing or public housing?
does the land exceed 2 hectares?

INSURANCE

What type of insurance do you require?

Sum of building insurance required (this link may assist in providing a calculation)
Insurance Calculator

Sum of building and contents insurance required (this link may assist in providing a calculation)
Insurance Calculator

Sum of contents insurance required (this link may assist in providing a calculation)
Insurance Calculator

Are there any interested parties to the property? (Mortgage, finance, caveats)

Interested Parties / Caveats

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Any related home/contents claims in the past five years
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Adam Patterson
Authorised Representative 1265869

Important Links

Financial Services Guide
UIG Letter of Engagement
Terms & Privacy Policy
Complaints & Disputes
Code of Practice

AP Insurance Brokers Pty Ltd
ACN 610 426 938
ABN 97 933 553 730
CAR 1256088

Contact

0421 697 694

adam@apinsurancebrokers.com.au

PO Box 2270
Ringwood North VIC 3134

Office Addresses (by appointment only):

Unit 9, 10-12 Sigma Drive,
Croydon South 3137

Suite 2, 24A Ranelagh Drive,
Mount Eliza 3930

Corporate Authorised Representative of United Insurance Group Pty Ltd
AFSL 327131 | ABN 31 131 564 522 | ACN 131 564