Online Forms Whether you’re after a simple form or a more complex one, we can help you design the one that suits your needs. Our forms feature multi step capability and will also allow the user to save and continue their form at a later time. Step 1 of 8 - Your Name 12% Can I start with your name?First Name* Last Name* Nice to meet you! What type of cover are you looking for?Cover Type* Thanks for your selection! Where do you currently live?Current Address* Street Address City State Postcode Great! What are your building and contents sum insured?Great! What is your building sum insured?Building Sum insured*Great! What is your contents sum insured?Contents Sum insured*Do you require cover for any portable items outside the insured address?* Yes No How much do you need?Do you require additional cover for valuable items?* Yes No How much do you need? Can you tell us about your home?Building type* Are you currently insured?* Yes No Who is the current insurer Is business conducted from home?* Yes No Occupancy typeSelect one...Owner OccupiedRent/LeaseHoliday HomeYear the building was constructed? What is the wall constructed of?Select one...Double BrickBrick vennerAluminiumFibro/Asbestoshardiplank/HardiflexConcreteSteelStoneVinyl CladdingWeatherboard/WoodSandwich FoamMud BrickStrawOtherWhat is the roof constructed of?Select one...TileTin/ Steel / ColourbondIron (Corrugated)AluminiumFibro/AsbestosConcreteSlateThatchTimberQuality of the buildingSelect one...Standard qualityAbove AverageTop of the rangeHow many storeys in the building?*Select one...123 or moreSplit levels are considered separate levels.Will the property ever be unoccupied for more than 100 days?* Yes No Is the property poorly maintained or in poor condition?* Yes No Is the property under construction/renovation?* Yes No Is the property heritage listed?* Yes No Can you tell us about your home security?Type of security on external doors* What type of window security do you have?* Type of alarm* Lets talk about your claims history for the past 3 yearsNumber of claims in last three years*Select one...0123456789+When did you make your most recent claim?Select one...Never202220212020201920182017201620152014Have you been declined insurance?* Yes No Have you had a claim declined?* Yes No Have you had any criminal convictions for fraud or arson?* Yes No Almost done! May I grab a few quick details?When would you like the policy to be effective from? DD slash MM slash YYYY Add this to an existing package?* Yes No Payment Type* Annual Instalments Email* Phone* Date of birth of the oldest insured* DD slash MM slash YYYY PhoneThis field is for validation purposes and should be left unchanged.
