Insurance Quote Form

Your Contact Details

Your Name
Your Email
Mobile / Phone

House & Contents Quote Details

Is Property already owned? Or to be purchased?

If purchasing, what is the settlement date?

Suburb/Town

State

Is the property

Property is made of

Approximate year of construction?

Date of Birth of Oldest person insured?

Building Replacement Value

Contents Replacement Value

(for owner occupied properties)

Any deadlocks on all accessible doors and windows?

Do you have an alarm? If yes, is the alarm local, or monitored (back to base by a security company)

In the last five (5) years, how many house and/or contents claims have been made by the insured or anyone living with them?

If you already own this property only:

How many of these claims have been burglaries at this address?

Car Insurance Quote Details

Car 1

Car 2

Where is the car parked overnight (suburb and postcode)?

How is your car parked?

Owner / Driver 1 - Date of Birth

Owner / Driver 1 - Male / Female

Owner / Driver 1 - Age started driving?

Owner / Driver 1 - How many AT FAULT claims in last 5 years?

Driver 2 - Date of Birth

Driver 2 - Male / Female

Driver 2 - Age started driving?

Driver 2 - How many AT FAULT claims in last 5 years?

Vehicle: Make

Vehicle: Model

Vehicle: Year

Vehicle: Manual or Auto

Vehicle: Colour

Vehicle: Security

Vehicle: Is car under finance? If yes, please list financier.

Value: Please input agreed value otherwise market value will apply

Any other details?

Feel free to input any other details you think we should know.

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