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Landlords Insurance Request Form

This form is for Permanently Leased Properties

click here for Airbnb/Short Term Rentals

Completed By*

Client Code

Insured Name*

Date of Birth*

Additional Insured

Date of Birth*

Street Name*

Suburb*

Postcode*

Interested Party

Construction Year*

Wall Construction*

Has the Property been renovated*

Rewired

Replumbed

Reroofed

Restumped

We will be doing renovations

None

Roof construction*

Floor Construction*

Number of Bedrooms*

Number of Bathrooms*

Pool/Spa*

Professionally Managed*

Is a business run from the property?*

Yes

No

Managing Real Estate Agent*

Building Type*

Security*

Deadlocks

Keyed Window locks

Local Alarm

Monitored Alarm

Standard locks only

Number of Storeys*

Land Size*

Building Sum Insured*

Contents Sum Insured*

Optional Covers Required

Loss of Rent

Rent Default

Theft by Tenant

Weekly Rental Amount*

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

Yes

No

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

Any additional notes/concerns

Current Policy Details

Insurance Status*

Cover required from*

Current Premium

Current Excess

Current Insurer

Payment Frequency*

Internal Use

PO Box 349, KYNETON VIC 3444

20 High Street, KYNETON VIC 3444

hello@macedonrangesinsurance.com.au

03 4411 2704

Important Information

Our Financial Services Guide

Insurance Brokers Code of Practice

Website by Techno Bird

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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