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 Address Line 2 City State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 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 typeSelect oneOwner OccupiedRent/LeaseHoliday HomeYear the building was constructed?Select one2020201920182017201620152014201320122011201020092008200720062005200420032002200120001990 - 19991980 - 19891970 - 19791960 - 19691946 - 1959 (Post War)1914 - 1945 (War)1891 - 1913 (Federation)Pre 1890 (Victorian)What is the wall constructed of?Select oneDouble BrickBrick vennerAluminiumFibro/Asbestoshardiplank/HardiflexConcreteSteelStoneVinyl CladdingWeatherboard/WoodSandwich FoamMud BrickStrawOtherWhat is the roof constructed of?Select oneTileTin/ Steel / ColourbondIron (Corrugated)AluminiumFibro/AsbestosConcreteSlateThatchTimberQuality of the buildingSelect oneStandard qualityAbove AverageTop of the rangeHow many storeys in the building?*Select one123 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*Select one0123456789+When did you make your most recent claim?Select oneNever20212020201920182017201620152014Have 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?Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Add this to an existing package?*YesNoPayment Type*AnnualInstalmentsEmail address* Phone or Mobile number*Date of birth of the oldest insured*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CAPTCHA
