Landlord Insurance Quote

Max Insurances

 

D1, 27-29 William Pickering Drive,
Rosedale, 0632

 

Phone  0508 629 5626

 

Tel: 09 913 3011
Fax: 09 913 3012

Tell us a bit about your property

Your Name

Date of Birth

Full Address of Property Being Insured

Postal Address (if different)

Contact Number

Your Email

Do you have existing insurance

YesNo

If your answer is 'Yes', can you tell us the insurance company name and your customer & policy no.

Replacement Value of Property $

Floor Area in Square Metres(m*m)

Type of Property

If your answer is 'Other" to previous question, please detail:

Year Home Was Built

Monitored Security Alarm

YesNo

Monitored Smoke Alarm

YesNo

Have you made any house claims in the past 12 months

YesNo

Is there any form of business run from this home

YesNo

Mortgagee

YesNo

If you answer is 'Yes' to previous question, please detail:

When is settlement date

Would you like a quote for your contents

YesNo

Contents Value (including contents in shed, garage and storage) $

Any other relevant information that may affect the insurance cover

Declaration: I/WE HEREBY DECLARE AND WARRANT that the answers given above are in every respect true and correct, and that I/We have not withheld any information within My/Our knowledge likely to affect the decision of the Company as to My/Our eligibility for insurance. This request and declaration shall be the basis of the quote request.

YesNo