| Proposed Policy Holder Full Name/s* | |||
| Project Street Number and Street Name* | |||
| Post Code* | City/Town* | ||
| Type of work to be performed* |
| Please specify the type of work* |
| Will all materials be stored in a locked premises or container when not fitted?* | |||||
| Building type* |
Please specify building type* |
Construction material* |
Please specify material type* |
| Project arranged by* | |||
| Builder Name* | |||||
| Owner Name* | |||||
| Have the works commenced* |
| Please provide a start date* | Have the works exceeded the Slab/Base/Foundation stage |
| Project start date (est)* | |||
| Height of the works* | |||||
| Construction period* | Please provide an estimated completion date |
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| Maximum excavation depth* | |||||
| Total area of building/s* | (sq/m) | ||||
| Is the site connected to mains water supply? | |||||
| Does the property have any water tanks, dams, etc, connect to fire pumps?* | |
| The distance from the property to the nearest fire station:* |
| Shortest distance to any land boundary* | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Does the project involve: | |||||
| A basement | A special foundation | Demolition | |||
| Piling or Underpinning | Steep Block | Reclaimed Land | |||
| Below or over water table | Historic or Heritage | Adjoining Property Protection Orders | |||
| Swimming pool | Blasting | Welding or flame cutting activities | |||
| Total Cost of the Project* | $ | (Total Replacement cost of the completed works) |
| Existing Building Sum Insured | $ | Often building Insurance (e.g. home insurance) does not provide cover while a building is under construction. We recommend existing building insurance |
| Public Liability* |
| Have you ever suffered any losses or claims? | |
| Please confirm if you have suffered any accidents or incidences that would give rise to a claim under this insurance? | |
| Have you ever had any insurance cancelled or declined or special terms imposed? | |
| Have you ever been charged or convicted of any criminal offence or declared bankrupt? | |
| Are you aware of any matters not disclosed above that are relevant to the underwriter's consideration of this insurance? | |
Please provide all relevant information to all questions answered “Yes”. Please include where applicable, dates, insurance companies, amounts claimed, and other information that may be relevant to the consideration of this insurance. : |
| First Name* | ||
| Surname* | ||
| Contact Postal Address same as Project Address? | ||
| Postal Address* | |||
| Post Code* | City/Town* | ||
| Phone Number* | (please include area code) | ||||||
| Fax Number | (please include area code) | ||||||
| Email Address* | |||||||
| How did you find us?* | Please provide
details |
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| Comments | ||||||