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Home Insurance Request Form

Select an option

New Client

Existing Client

Completed By

Contact Name

Email

Phone

Date of Birth

Secondary Contact

Date of Birth

Insured Name

Property Address

Is the property under finance?

Year Built

Has the property been renovated? eg. Rewired/Replumbed

Wall Construction

Floor Construction

Roof Construction

Number of Bedrooms

Security

Deadlocks

Keyed Windowlocks

Local Alarm

Monitored Alarm

Number of Bathrooms

Business run from the property?

Number of Storeys

Land Size

Do you have any animals or farm vehicles?

What are you most concerned about?

Bushfire

Flood

Accidental Damage

Are my sums insured high enough

I've had a bad claim experience before

Just the usual

Is there any risk of Flood to your home?

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 etc?

Have you made any claims in the past 3 years?

Yes

No

Add claim details

Additional notes

Insurance Status

Payment Frequency

Select a date

Current Insurer

Internal Use

PO Box 349, KYNETON VIC 3444

20 High Street, KYNETON VIC 3444

hello@macedonrangesinsurance.com.au

03 4411 2704

Important Information

Privacy Policy

Insurance Brokers Code of Practice

Our Financial Services Guide

Internal Use

Complaints

Contact Us

Macedon Ranges Insurance Pty Ltd | ABN 65 672 507 191 | AR No. 1283072 Authorised Representative of PSC Connect Ltd ABN 23 141 574 914 AFS License No 344648.

We are a PSC Network Insurance Partner and part of the PSC Insurance Group, a publicly listed multi-national Insurance Broking company with global reach. We have the size and scale to help you protect your operations and assets by providing appropriate advice and the ability to leverage our scale with leading insurers, underwriting agencies, and access to the London insurance market. We benefit from knowledge across a broad range of industries so we can focus our efforts on understanding every customer, every policy and every risk, ensuring our clients have access to a wide range of insurance companies, a broad range of products, and highly-competitive industry pricing.

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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