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Owner Builder Construction and Public Liability

Please fill in all "Mandatory Field" sections and provide as many details as possible to speed up the processing of your request. You will receive a reply within two business working days!!

 
First Name:
  *
Last Name:
  *
Phone:
  *
Fax:
Email:
  *
Street Address:
  *
Suburb:
  *
Post Code:
  *
State:
  *
Site Address same as Postal Address:
  *
Site Street Address:
Site Suburb:
Site Post Code:
Site State:
Project Type:
  *
Roof Type:
  *
Brief Description of Works:
  *
Cost of work to be carried out or remaining (Builder's Cost $):
  *
Liability Limit:
  *
Construction Start Date:
  *
If construction has commenced, brief description of works completed so far:
If contruction has commenced total cost of works completed so far ($):
Any excavations more than 2 metres deep:
  *
Please type N/A, if not applicable
If yes, provide details (if excavation is more than 2m deep):
Details of any work on or near water:
Details of any Piling, Shoring or Underpinning works:
Any works over two stories high:
  *
Any Demolition above 5 metres high:
  *
If you are Renovating an Existing Dwelling Only.
Age of Existing Dwelling (years):
  *
Please type N/A, if not applicable
Is Existing Dwelling Free Standing:
  *
Please type N/A, if not applicable
Any Heritage Listing or Overlays:
  *
Please type N/A, if not applicable
Any Re-stumping of existing structure:
  *
Please type N/A, if not applicable
How will the home contents be secured:
Have you received written confirmation that your Home & Contents Policy will remain valid when works commence?:
If you answered 'Yes' above, indicate the name of the insurer for Building and Contents:
If you answered 'No' above, would you like a quote for Home Protection Insurance:
What would be the Replacement cost of the existing structure:
What would be the Building Contents cost:
Have you made any claims for Home and Contents or Construction insurance in last 5 years:
  *
Have you had any criminal convictions in last 5 years:
  *
Have you ever been declared Bankrupt:
  *
Have you ever been involved in a Company or Business that has gone into Liquidation or Receivership:
  *
Under the Insurance Contracts Act 1984 (the Act), you have a Duty of Disclosure. You are required before you enter into, renew, vary, extend or reinstate your policy, to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision whether to insure you, and anyone else to be insured under the Policy, and if so, on what terms. If you do not comply with your Duty of Disclosure we may reduce or refuse to pay a claim or cancel your Policy. If your non-disclosure is fraudulent we may treat this Policy as never having worked.
Declaration:
I / We confirm we have read the Duty of Disclosure included in this application form and confirm the answers are true correct and that no information has been withheld which may affect the decision to accept this application or the terms and conditions.
  *
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