Strata Insurance Questionnaire

Please complete the following form with as much detail as possible to enable us to get the best possible quotation and insurance solution for your requirements. When completed please submit by clicking the submit button at the bottom of the form. Your personal broker will be in contact very shortly. Thank You.

Strata Plan Number:
Address:

Is the Building professionally managed? Yes   No

If yes, please provide management details:
Name:
Contact Number:
Email Address:

 

Building Details
Year of Construction
Date of latest valuation
Number of Lots
Residential:          
 
Commercial:         
 
Holiday Letting:     
 
Are all dwellings occupied?                                Yes                No
Number of Floors
Above Ground: 
 
Below Ground: 
Garage/Parking Details
Number car spaces/garages: 
 
Is there a security gate with remote access?      Yes                No
 
Is each park/garage individually gated?              Yes                No
Number of Basements
Number of Lifts
Number of Escalators
Number of Pools/Spas
Number of Water Features
Number of Playgrounds
Number of Gyms
Number of Pontoons/Jetties
Number of Tennis Courts
Any Kitchen/Dining Facilities?
 Yes                No
 
Details: 
Any Plant Machinery?
Yes                No
 
Details: 
Construction Details
Walls - Internal
Walls - External
Floor
Roof
Cladding?
 Yes                No
Material:      
 
Percentage: 
Expanded Polystyrene (EPS)?
 Yes                No
Percentage: 
Known defects?
Yes                No
Details: 

 

Security & Fire Safety
Burglar Alarm Yes                No
Back to base Alarms  Yes                No
Local Alarm Yes                No
CCTV Yes                No
Bars on Windows Yes                No
Window Locks Yes                No
Deadlocks on doors Yes                No
Security lightings Yes                No
Security Patrol Yes                No
Smoke Alarm Yes                No
Monitored Alarm (Fire) Yes                No
Local Alarm (Fire) Yes                No
Sprinklers Yes                No
Fire Extinguishers Yes                No
Hose Reels Yes                No
Fire Blanket Yes                No
Flood Prone Area? Yes                No

 

Insurances Required
Buildings Sum Insured Yes                No
Catastrophe cover required? Yes                No
Loss of Rent

Yes                No

 15%      30%
Common area contents Yes                No
Paint/ Wall paper required? (NSW/ACT only) Yes                No
Lot Owners Fixtures Yes                No
Floorboards Cover required? Yes                No
Flood Cover required? Yes                No
Worker’s Comp. Required? Yes                No
Fidelity Guarantee Yes                No
Public Liability Yes                No
Office Bearers Liability Yes                No
Machinery Breakdown Yes                No
Legal Expenses Cover Yes                No
Personal Accident Cover Yes                No

Is the Building currently insured? Yes   No

If yes please provide details in the spaces below
Insurer
Policy Number
Premium
Excess
Renewal Date

Please detail any losses the building has experienced over the last 5 years

Date of Loss
Description of loss
Insurer
Amount
Date of Loss
Description of loss
Insurer
Amount
Date of Loss
Description of loss
Insurer
Amount

Duty of Disclosure

Please answer the all of the questions below:

In the last 5 years has an insurer ever Y/N
Decline an insurance proposal/renewal/ claim? Yes                No
Cancel an insurance policy? Yes                No
Impose conditions on the policy? Yes                No
If any answer is ‘Yes”, please provide details below.

Declaration by Client

By signing this document I/we declare that:

  1. The statements in this Needs Analysis/Proposal Form are true & correct.
  2. That all maters disclosed to my/our knowledge you should be aware of and in particular, I/we have fully disclosed my/our Objectives, Financial Situation and Needs relevant to this insurance.
  3. That no Insurance Company has ever cancelled, declined or refused to renew or imposed special terms or cancelled any Policy held by me/us.
  4. That I/we agree to accept the terms, exclusions, conditions and limitations of the Policy(s) effected on my behalf by you in respect of the insurances obtained in respect of the above.
Client Full Name:
Position:
Signature:
Date:

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