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Your Details

Your Name:*:
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Which of these best describes you:

About Your Building

Strata Plan No:
Address Of Premises:
Period Of Insurance:
From: To:
Previous Insurer:
Policy Number:
Type: ResidentialCommercialIndustrial
No Of Lots:
No Of Buildings:
Age Of Building/S:
No Of Floors:
Construction Of Floors:
Construction Of Walls:
Construction Of Roof:
Pool: YesNo
Elevator: YesNo
Building Sum Insured $:
Contents Insurance $:
Loss Of Rent $:
Public Liability $:
Office Bearers $:
Personal Accident $:
Machinery Breakdown $:
Other Insurances - Detail:
Workers Comp. Wage Est:
Premises Unoccupied: YesNo
No Of Units Vacant:

Other details pertaining to proposal

Public liability claims history - If known

5 year claims history - If known



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