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Home Insurance Request Form

Completed By*

Client Code

Phone

Insured Name*

Date of Birth*

Additional Insured

Date of Birth

Street Name*

Suburb*

Postcode*

Real Estate Listing

Interested Party

Occupancy Type*

Building Type*

Construction Year*

Wall Construction*

Roof construction*

Floor Construction*

Has the Property been renovated*

Rewired

Replumbed

Reroofed

Restumped

We will be doing renovations

Number of Bedrooms*

Number of Bathrooms*

Is there a business run from the property?*

Yes

Security*

Deadlocks

Keyed Window locks

Local Alarm

Monitored Alarm

Standard locks only

Number of Storeys*

Land Size*

Level of Cover Required*

Building Sum Insured*

Contents Sum Insured*

Need help with your sums insured? We have online calculators available here and can provide further guidance if we notice any inconsistencies.

Do you require cover for valuables/collections/bicycles etc?

Have you made any claims in the past three years?*

Yes

What are you most concerned about?*

Product Coverage

Claims Service

Insurance affordability

Any additional notes/concerns

Current Policy Details

Insurance Status*

When is cover required from*

Current Insurer

Payment Frequency*

Current Premium

Current Excess

Internal Use

REQUEST A QUOTE

PO Box 349, KYNETON VIC 3444

20 High Street, KYNETON VIC 3444

hello@macedonrangesinsurance.com.au

03 4411 2704

Important Information

Internal Use

Insurance Brokers Code of Practice

Macedon Ranges Insurance Pty Ltd | ABN 65 672 507 191 | Authorised Representative of Ausure Pty Ltd ABN 94 096 971 854 AFS License No 238433

Disclaimer: The information provided on this website is for general information purposes only, and it is not a substitute for professional advice. You should always consider the PDS/Policy wording before making a decision. Coverage may differ based on specific clauses in individual policies. Refer to the FSG on our website or by requesting a copy for our services and remuneration details.

Macedon Ranges Insurance is a member of NIBA and endorse the Insurance Brokers Code of Conduct which can be found here.

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