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?Address* Street Address 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?*YesNoHow much do you need?Do you require additional cover for valuable items?*YesNoHow much do you need? Can you tell us about your home?Building type*Are you currently insured?*YesNoWho is the current insurerIs business conducted from home?*YesNoOccupancy typeOccupancy typeOwner OccupiedRent/LeaseHoliday HomeYear the building was constructed?Year the building was constructed?20212020201920182017201620152014201320122011200020092008200720062005200420032002200120001990 - 19991980 - 19891970 - 19791960 - 19691946 - 1959 (Post War)1914 - 1945 (War)1891 - 1913 (Federation)Pre 1890 (Victorian)What is the wall constructed of?What is the wall constructed of?Double BrickBrick vennerAluminiumFibro/Asbestoshardiplank/HardiflexConcreteSteelStoneVinyl CladdingWeatherboard/WoodSandwich FoamMud BrickStrawOtherWhat is the roof constructed of?What is the roof constructed of?TileTin/ Steel / ColourbondIron (Corrugated)AluminiumFibro/AsbestosConcreteSlateThatchTimberQuality of the buildingQuality of the buildingStandard qualityAbove AverageTop of the rangeHow many storeys in the building?*How many storeys in the building?123 or moreSplit levels are considered separate levels.Will the property ever be unoccupied for more than 100 days?*YesNoIs the property poorly maintained or in poor condition?*YesNoIs the property under construction/renovation?*YesNoIs the property heritage listed?*YesNo 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*Number of claims in last three years0123456789+When did you make your most recent claim?When did you make your most recent claim?Never20212020201920182017201620152014Have you been declined insurance?*YesNoHave you had a claim declined?*YesNoHave you had any criminal convictions for fraud or arson?*YesNo Almost done! May I grab a few quick details?When would you like the policy to be effective from? Date Format: DD slash MM slash YYYY Add this to an existing package?*YesNoPayment Type*AnnualInstalmentsEmail* Phone*Date of birth of the oldest insured* DD MM YYYY CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.