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HOME OWNERS INSURANCE PROPOSAL
CONTACT
Ph 09 278 8800
Mobile-0274386387
Email:admin@fundagroup.co.nz
ADDRESS
Unit 1D 39
East Tamaki Road Papatoetoe
PO BOX 72626 Papakura 2244
Insurance
Select Insurance Type
Select
Home Insurance
Home And Content Insurance
Content Insurance
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Reload
Personal Details
Insured Title / Trust Name (if applicable):
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Surname(Applicant 1) :
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Surname(Applicant 2) :
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First Name :
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First Name :
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Date of Birth :
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Date of Birth :
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Occupation :
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Occupation :
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Telephone :
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Characters are not allowed!
Telephone :
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Email :
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Please enter valid Email Id!
Postal Address :
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Number :
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Street :
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Suburb :
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City :
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PostalCode :
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DWELLING RISK DETAILS
Property Address :
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Number :
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Street :
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Suburb :
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City :
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PostalCode :
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Occupancy Type:
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Owner/Family
Tenanted/Rental
Holiday Home
Unoccupied
Other
Please advise if short term rental:
Replacement Sum Insured:
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Total Floor Area (SQM):
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(The home including ALL levels, attached or detached garage, conservatory, developed basement and decking)
What Type of Home is this:
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Freestanding
Semi-detached
Attached
Apartment
Year Built:
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(if pre-1945 please complete Questionnaire form)
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Number of Stories:
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How many self-contained units:
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(Self-contained means with a ‘fully’ functional kitchen & bathroom facilities)
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Dwelling Construction:
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This field is required!
What is the main water supply:
Town
Tank
Land Size (SQM):
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Is this a Lifestyle Block:
Select
Yes
No
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Do you have any livestock:
Select
Yes
No
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Details
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Is there any Agricultural or Horticultural Use:
Select
Yes
No
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Details:
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Is there a Mortgage:
Select
Yes
No
This field is required!
with Whom:
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Is any part of the property used for any business, trade or profession other than as a home office or residential rental property?
Select
Yes
No
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*If yes:
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B&B/Lodge
Airbnb
Other
Please Provide details:
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Dwelling occupied at Night:
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Select
Yes
No
Security Alarm System:
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Select
Yes
No
Audible
Monitored
by whom:
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STANDARD EXCESS REQUIRED (Dwelling):
(NB. For tenanted/Rental Homes an additional $250 excess will apply)
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$500
$800
$1,000
FOR TENANTED PROPERTIES ONLY:
The cover on a tenanted property has a higher standard excess and is subject to specific conditions. Please refer to the policy wordings for full details.
1. Are frequent internal and external inspections carried out by you or your property manager?
Select
Yes
No
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*If no, please explain reasoning:
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2. Has there been any damage by tenants (whether insured or not) in the past 5 years?
Select
Yes
No
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*If yes to question 2 please provide full details:
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3. Who manages the property (name of agent)?
Select
Yes
No
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4. What is the weekly rent ($)?
Select
Yes
No
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Landlord’s Extension - Do you want to purchase this Optional Additional Benefit? (Loss of Rents $50,000; and Malicious Damage by tenant $30,000; and Methamphetamine contamination). Please note that special terms and conditions of the insurance policy apply.
Select
Yes
No
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GENERAL PROPERTY QUESTIONS
1
Is the property watertight, structurally sound, secure and well-maintained?
Select
Yes
No
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*If no, please give details:
2
Is any part of the property damaged or in need of repair?
Select
Yes
No
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3
Is any part of the property undergoing renovation or alteration, or that is partially built?
Select
Yes
No
4
Has the property been identified by the council as being at risk from any natural hazard, such as flooding or inundation erosion or subsidence?
Select
Yes
No
*If you have answered yes to any question above, please provide full details and complete the Flood/Landslide Questionnaire
CONTENTS RISK DETAILS
Property Address :
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Number :
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Street :
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Suburb :
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City :
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This field is required!
PostalCode :
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This field is required!
Security Burglar Alarm System:
This field is required!
Select
Yes
No
Audible
Monitored
by whom:
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General Sum Insured:
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Sum Insured Specified Items:
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TOTAL Sum Insured:
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Occupancy:
Who lives here:
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Insured & Family
Holiday Home
Unoccupied
Insured & Flatmates
Other
If other, please state whom:
Who will be covered:
This insurance will cover Contents owned by the person making this application, and their husband or wife, or person with whom they are living in the nature of a marriage and their family who live at the address above.
Is insurance required for Contents owned (or jointly-owned) by anyone else? (eg. G/Parent, in-laws etc).
Select
Yes
No
*If yes, you must give their details, or their contents will not be covered:
SPECIFIED ITEM LIMITS
Limits on what we’ll pay you
Unless this policy specifically states otherwise in another section, the most we’ll pay in total for any event, is the sum insured that is shown on the schedule.
Specified limits for certain types of items
Unless they are noted separately on the schedule, the maximum amount of cover per event for the following items is shown below. Type of item
Maximum per event
Art and ornaments
$100,000
For a single ornament, painting, picture or work of art.
$250,000
For all ornaments, painting, picture or work of art.
Bicycles and e-bikes
$5,000
For a single bicycle.
Cameras
$5,000
For a single camera (film, video or digital) including any lens which came with the camera body, or any single lens or accessory.
Collections
$5,000
For a single collection of any type including coin, stamp, card or medal collections.
Jewellery
$5,000
For a single item of jewellery or watch.
$15,000
For all items of unspecified jewellery and watches (not including those noted on the schedule).
Money and vouchers
$1,000 (NZD)
For all money, vouchers that can be redeemed for cash, bullion, unset precious stones, credit cards or stamps that are not part of a collection combined.
Remotely piloted aircraft
$3,000
Parts and accessories
$1,000
Parts and accessories
$1,000
Combined limit for all parts and accessories of:
Watercraft,
Vehicles,
Motor cycles,
Motor scooters,
Trailers and caravans,
Aircraft and other aerial devices (other than remotely piloted aircraft) that are covered under this policy.
Watercraft
$3,000
For a single watercraft item.
Do you wish to apply for cover above any of these limits?
Select
Yes
No
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**If yes, please list them below **Please note that a current valuation/or invoice will be required in order to support the value requested. Note: The policy does contain other limits – Please refer to the policy wording for full details.
Item
Valuation Description
Value
1.
2.
3.
4.
STANDARD EXCESS REQUIRED (for Contents):
This field is required!
$250
$500
$1,000
PERSONAL DECLARATION QUESTIONNAIRE
Have you or any member of your family, de facto partner, trustees and/or beneficial owners, or any other person or entity to be covered by the insurance proposed:
1
Ever been Bankrupt/ Liquidated, and or been through the No Asset Procedure in the past 10 years?
Select
Yes
No
This field is required.
2
Had any insurance losses in the last 3 years?
Select
Yes
No
This field is required.
3
Had any insurance loss exceeding $25,000 in the last 3 years?
Select
Yes
No
This field is required.
4
Engaged in any criminal activity or had any criminal convictions, acquittals or have criminal prosecutions pending?
Select
Yes
No
This field is required.
5
Ever had any insurance declined, cancelled, renewal refused, specific terms or condition imposed, or any claim declined?
Select
Yes
No
This field is required.
6
Ever been subject to lawsuit or a legal liability claim?
Select
Yes
No
This field is required.
7
Suffered from Flooding or Landslip at this address?
*(If yes, please answer the Flood and Landslide Supplementary Questionnaire attached)
Select
Yes
No
This field is required.
8
Is there any further information likely to have any material impact on this insurance?
Select
Yes
No
This field is required.
If you have answered YES to any of the above Declaration questions, please provide full details including Date of Loss, Description of incident, and settlement amount ($) - in the space below.
USE OF INFORMATION
This form collects personal information about you which would influence the judgement of a prudent underwriter when considering your request for insurance. It will be held by, or on behalf of, The Insurance Group Limited, and the insurers with whom your insurance is placed. You may request access to, and correction of, this information subject to the provisions of the Privacy Act 1993.
DECLARATION
1. I hereby declare that the above supplied information and statements of this questionnaire being submitted for consideration are true, that I have not suppressed or misstated any material facts.
2. I agree that this application shall be the basis for which coverage is being considered and this information will form part of the policy.
3. I am aware that I will be liable for damages incurred due to any material or negligent misrepresentation(s) and that such material misrepresentation(s) may render the policy void ab initio.
"I confirm that above is true to the best of my Knowledge".
"I am interested in claimyexcess.com- which reimburses Claim Excess."
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CANCEL
TAXI INSURE – INSURANCE APPLICATION FORM
This is an application for insurance. Insurance does not commence until the proposal has been accepted by an insurance company and confirmed to you in writing by us and premium is paid or agreed to be paid.
We are required to provide a Duty of Disclosure notice to you. Our Policy Quotation is based on information you have supplied. Please ensure that you have carefully read all Duty of Disclosure questions prior to signing the declaration. Your Duty of Disclosure requires you to tell us the relevant information that may affect the decision to provide insurance cover and/or the terms and conditions of the insurance. Each person(s) or entity named as the Insured has this duty of disclosure. Any Non-Disclosure of relevant information may result in the refusal of claims and/or cancellation of the insurances.
UBER/Taxi use is Named Drivers Only and subject to having P Endorsement
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