landlord's insurance

Please complete this questionnaire to apply for Landlord's Insurance.
YOUR CONTACT DETAILS
Your Name
Contact Phone Number
Fax Number
Email Address
ADDITIONAL DETAILS
Name of proposer
Postal Address
Situation of risk
Interested Party
OTHER DETAILS
Construction
Building age
Has the building been rewired?
What is the condition of the building?
Building is used as
Building occupied by
Type Of Home
Is the Building Heritage Listed?
SECURITY
Does the building have deadlocks?
Does the building have window locks
Does the building have an alarm
If Yes, is it
PREVIOUS INSURANCE
Has the insured had previous insurance for the cover now requested?
If Yes, please provide name of insurance
If Yes, please provide expiry date   Year 
If No, please give reason
INSURANCE HISTORY
During the last five years, has the insured had any of the following
Any insurance declined or cancelled
Excess or special condition imposed
Renewal declined or refused
Any previous claims rejected
Claims for the type of insurance requested
Criminal conviction or declared bankrupt
If yes to any of the above please give full details
BUILDING CONTENTS
Building Sum Insured Required $ 
Landlord Fixtures and Fittings Sum Insured Required $ 
Loss of Rent (Weekly) $ 
Rent Default


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DECLARATION

By Pressing the 'Send Questionnaire' button, we declare that to the best of my/our knowledge and belief the above statements and particulars are true and correct.