INSURED'S - Details

  Builder Name

(builder or project manager, if applicable)

  Address of Project*

 City/Town*

Post Code*

  Postal Address*

 City/Town*

Post Code*

PROJECT - Details

 Type of work to be preformed

Please Select Extension Only - To an Existing Residential Building Extension Only - To an Existing Commercial Building Extension and Renovation - To an Existing Residential Building Extension and Renovation - To an Existing Commercial Building Renovation Only - To an Existing Residential Building Renovation Only - To an Existing Commercial Building New Building - Home/Units (Single) New Building - Home/Units (More than 1) New Building - Commercial (Factory/Warehouse/Office/Retail) Kit Home Civil / Civic / Roads Other

 Construction Material

Brick/Concrete Other

if other please specify

 Project arranged by

Owner as Builder (engaging conctractors) Registered Builder or Project Manager

 Have the works commenced

No Yes

if yes please specify provide a start date

 Height of the works

1 Storey 2 Storey 3 Storey Over 3 Storey

 Construction Period

Up to 12 Months More the 12 Months

if more that 12 months provide estimated completion date

 Total area of building/s*

 Does the project involve

 INSURANCE – Details

Replacement/Rebuilding Cost of Project*        $

Tools and Equipment Sum Insured                 $

 PREVIOUS INSURANCE - Details

  Have you ever suffered any losses or claims?

No Yes

  Have you ever had any insurance cancelled or declined or special terms imposed?

No Yes  

  Have you ever been charged or convicted of any criminal offence or declared bankrupt?

No Yes  

  Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?

No Yes  

 CONTACT – Details

First Name*

Surname*

  Phone Number

   (please include area code)

Email Address*

How did you find us?*
---Please Select--- American Vehicle Sales Better Buying Group Building Commission Building Industry Solutions Building Inspector Conveyancer Fair Trading Dept NSW Friend or Family Member Google Search Government Department Im a Existing CGIB Client Insurance Broker Insurance Company Internet Search Steadfast White Pages www.ownerbuilder.net.au Yellow Pages Book Yellow Pages Online Other if other, please provide details

 * Mandatory Fields

Thanks for completing our online form.

We will endeavour to contact you with your insurance details soon.

Meanwhile, if you require any further assistance please feel free to contact us.

We may need to contact you to obtain additional information to provide you with an insurance quotation.

Completion of this form does not put an insurance policy/cover in place - you will need to contact us to arrange insurance cover.

All information you provide must be correct, true, and accurate as incorrect or misleading information may alter our quote and jeopardise cover if you proceed with a policy.

We recommend that you read the relevant Product Disclosure Statement when considering an insurance policy.