Landlords-Insurance-Fact-Find

🏢 Select Office

Select Office:

—Please choose an option—WebInsure (Head Office)Ipswich Insurance BrokersWideland Insurance BrokersGranite Belt Insurance BrokersGold Coast Insurance BrokersGold Coast Financial Advisers

👤 Client Details

Full Name:

Email:

Phone:

Property Address:

ABN (if applicable):

GST Registered?

YesNo

🛠️ Claims & Disclosure

Any claims in the past 5 years?

YesNo

If yes, please provide details:

Has any policy ever been cancelled, declined, or had special terms imposed?

YesNo

Have you ever been bankrupt or insolvent?

YesNo

Other disclosures:

🏡 Property Details

Occupancy Type:

—Please choose an option—Single TenancyMultiple TenantsHoliday LetOther

Number of Units:

Year Built:

Wall Construction:

Roof Construction:

Floor Construction:

Are there smoke alarms?

YesNo

Alarm Type:

HardwiredBattery

Fire Protection:

ExtinguishersFire Blanket

Security Details (locks, alarms, cameras):

Is the property currently vacant?

YesNo

If yes, please complete the following:

How long has the property been vacant?

Is the property expected to be vacant for more than 60 days?

YesNo

📜 Under Contract

Is the property currently under contract?

YesNo

If yes, expected settlement date:

🛋️ Sum Insured

Building Sum Insured:

Contents (if applicable):

Loss of Rent Cover:

Is the property leased through a real estate agent?

YesNo

Real Estate Agent Name:

Real Estate Agent Address / Contact:

Liability Limit:

—Please choose an option—$5 million$10 million$20 million

🏦 Financier Details

Is there a financier/lender involved?

YesNo

Financier Name:

Financier Contact Details:

📝 Notes / Other Information

Any other notes or relevant information:

🧑‍💼 Broker Reference (Optional)

Broker Name:

Broker Email: