HOUSE AND CONTENTS INSURANCE PROPOSAL
No risk attaches until the proposal has been accepted by the company and premium is paid or agreed to be paid
Your Details
Full Name:
Address:
Occupation:
Contact details:
Postal Address:
Telephone
Work:
Home:
Mobile:
E mail:
YOUR DUTY OF DISCLOSURE
You must tell us everything you know (or could be reasonably expected to know) that a prudent insurer would want to take into account in deciding:
Whether to accept your proposal, and
f so, on what terms.
Examples of what you must tell us include:
Anything that increases the risk of a claim
Any criminal offending or convictions
Any previous insurance claims
Any refusal by another insurer to insure you on standard terms, or continue to insure you on standard terms
Your Privacy
We collect and receive your personal information in this proposal to decide whether to insure you. We hold it in our records. You have rights to access it, and correct it under the Privacy Act 1993.
You must supply your personal information to us if it comes within your duty of disclosure (see Your Duty of Disclosure above). If you fail to do so, we may decline your proposal or avoid your insurance retrospectively. We obtain your authority below to transfer some or all of it to other members of the insurance industry, financially interested parties noted on your policy and Insurance Claims Register Limited.
YOUR PREVIOUS HISTORY
Has any insurer ever refused to insure you on standard terms, or refused to renew your insurance on standard terms?
Yes
No
Has any insurer ever refused to pay your insurance claim?
Yes
No
Have you made any insurance claim in the last five years?
Yes
No
Do you know of any circumstances that could lead to a claim under any of our policies in the future?
Yes
No
Do you have any criminal convictions (including traffic offences, but not parking offences), or are you currently facing a prosecution?
Yes
No
If yes, please list each offence or prosecution, and each sentence your business has received.
If you have answered yes to any of the above questions, please write full details below
HOUSE INSURANCE
Please complete this section if you require House Insurance.
Is your property
Detached house
Flat/apartment
Home unit
Part of a residential only body corporate
How many buildings are on the property?
Who occupies your property?
You and your family members and/or others
Relatives/employees
Tenants
Unoccupied
If tenanted, do you or an agent inspect the property regularly?
Yes
No
Has there been any damage resulting in an insurance claim in the last five years?
Yes
No
When was your house built?
What is the house size (floor area in square meters)?
What is the present value of the house (excluding the land value)?
Do you know the replacement value?
Yes
No
If so please advise :
Do you use the property as a business or trade?
Yes
No
If Yes, please describe.
Does the property require repairs?
Yes
No
If so, please list.
Are you currently renovating any of the property?
Yes
No
If so, please list
Has the property ever suffered flooding or landslides
Yes
No
CONTENTS INSURANCE
Please complete this section if you require Contents Insurance.
Please list the address of where the contents are stored:
Who owns the property where your contents are located?
If it is your home, what type of property is it?
Main home
Holiday home
Tenanted property
Unoccupied
If you don't own the property, are you:
Living alone and/or with family
Have flat mates
Who else requires contents cover?
What is the total value of the contents insured?
Does the property have a burglar alarm?
Yes
No
If so, please describe.
Do you have deadlocks on the doors/windows?
Yes
No
Please read the policy for specific limits on the sums insured for certain contents. Please contact us if any of the items are valued in excess of those individual limits and you require additional cover.
YOUR DECLARATION
I declare that I:
1. Have answered all questions truthfully.
2. Have, in addition, disclosed all material facts to New India (please see your duty of disclosure above)
3 Agree to the policy terms and conditions.
4 Authorize:
4.1 New India to advise me of its other services from time to time.
4.2 The disclosure of my personal information held by New India to:
4.2.1 Other members of the insurance industry, and
4.2.2 Financially interested parties noted on the policy, and
4.2.3 Insurance Claims Register Limited.
4.3 The disclosure of my personal information held by:
4.3.1 Other members of the insurance industry, and
4.3.2 Insurance Claims Register Limited to New India for the purpose of considering this proposal and administering the policy.