Piranha Insurance Brokers
Piranha Insurance Brokers
[Note: We are licensed to provide insurance cover for Australian residents only]
Please ensure that all details are correct and complete. Thank You
Name    Contact Number
Email     Fax    Mobile
Address    Post Code
  
Dates Of Birth Of Insured    / 
Existing Policy No    Due Date
Situation Address   Postcode 
  
Policy Required
Owner Occupied    Landlord    Holiday Home    Contents Only
Does the property have Reticulated Water & Fire Brigade Services?
Yes No
If No, provide details
Are all people living at this address Family Members?   Yes No
If No, how many non-related people?
If No to above, please advise
Is the building on Acreage? Yes No      No of Acres?    
Neighbourhood Watch Area?   Yes No
 
Acreage: Does the Property have livestock or machinery? Yes No
Details
   
Building Construction: (Timber / Brick) 
Roof Construction: (Iron / Tile) 
Age of Structure:   yrs.   Does this property have a pool/spa?
Yes No
  
Note: If over 30 years, has the building been renovated?
Wiring? Yes No      Plumbing? Yes No   Roof? Yes No
Other (Give Details)
 
Replacement Values
Value Of Building     Other Structures    Total
Value Of Contents     Personal Valuables   Total
Security (ie; Deadlocks, Keylocks, Alarms etc)
   

Claims and Conviction Details

 
Is any Part of the Property for 'Business Purposes? Yes No
Type of Business
  
Landlord Cover
Loss Of Rent  Yes / No     Rent Per Week
Rent Default / Tenant Damage Insured w Yes No
   
Thank you for completing our House and Contents Cover Online Quotation Form.
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