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Professionals Home Plan

Domestic Package Insurance
 
Contact Details
Name*
Address*
Phone* Fax
Email* Date of Birth*
* required      
 
House Details
Address
Year Built
Occupancy
Total Floor Area (square metres)
Replacement Value (Holiday Homes and Rental Properties)
    
 
Contents Details
Address
Sum Insured
Occupancy
Professionally Installed alarm Yes     No
Specified Items
(over $5000)
   

Motor Vehicle Details
Vehicle 1 Vehicle 2
Year
Make
Model
Registration

Market Value

 
Have any modifications been made to the above vehicles?
Yes No
Has any driver been convicted of a driving offence?
Yes No
Have any drivers been involved in an at fault accident?
Yes No
 
Boat Details 		 
Hull, Fixtures & Fittings
Dinghy, Tender or other small craft
Motor(s)
Trailer
Accessories
Racing Risks
Purpose and Area of use

How do you wish to receive your quote?

Please note
that this form is for the purpose of providing a quotation only. All quotes are subject to the completion of the Insurer's proposal form and acceptance by the Insurer(s).
 
  
  
 
   

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