GNG: Insurance Broker

On-line Home Insurance
home


Thank you for considering our on-line home insurance service.    Because Greater National Group is an insurance broker, not an insurance company, we will process your application with major insurance companies in order to find you the best home insurance deal possible.

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond with your terms as soon as we have researched the market for the best available deals that fit your requirements.

For a standard home, please click here
For landlords, please click here
For a prestige home, please continue with this form



About the property you wish to insure:
1a. Postcode:
1b. Age of house:  years
1c. Age of oldest person at home:
1d. Are they retired?
Yes No
1e. Are they a pensioner?
Yes No
1f. Construction:
1g. Current occupancy status:
1h. Is the house on more than 1/2 an acre?
Yes No
1i. Is the house in Neighbourhood Watch?
Yes No
1j. Is the house connected to town water?
Yes No
About the value of insurance you are seeking:
2a. Building sum insured: $ 
2b. Contents sum insured: $ 
Extra protection for accidental loss or damage (this is an additional cost):
3. Unspecified Valuables: $ 
4. Specified Valuables:
4a. Art: $ 
4b. Music: $ 
4c. Jewellery: $ 
4d. Photographic equipment: $ 
4e. Bikes: $ 
4f. Computers: $ 
4g. Laptops/Phones: $ 
4h. Excess you would prefer to pay on this policy:
(Excess is the amount you pay out of each claim you make)
Security information about the house:
5. Doors:
5a. Are there deadlocks on all external doors?
Yes No
5b. Do all sliding doors have patio bolts?
Yes No No sliding doors
6. Windows:
6a. Are there keyed locks on all windows?
Yes No
6b. Are all louvre windows barred?
Yes No No louvre windows
7. Other security information:
7a. What kind of alarm system (if any) is present?
Audible Monitored None
7b. Is there a 1kg dry chemical fire extinguisher in the house?
Yes No
7c. Are there 2 or more smoke detectors in the house?
Yes No
Insurance history of the house:
8a. Claims free years:
8b. Previous or current insurer:
8c. Due date of policy (dd/mm/yy):
8d. Amount paid: $ 


Duty of Disclosure:
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?
Yes No

If so, please provide details below:
I/We hereby declare that:
My/Our attention has been drawn to the Important Notices accompanying this form and further I/we have read these notices carefully and acknowledge my/our understanding of their content. The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this form and the inception date of the insurance to which this relates I/we shall give immediate notice thereof. I/We authorise GNG and the Insurer to collect or disclose any personal information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact and the Privacy Policy. I/We also confirm that I/we am/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this form and I/we complete this form on their behalf.
Any other comments, requests or relevant information you need to add:
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss quote details in person. Please leave a contact phone number and best time to call to facilitate this.
Your name:
Company/Business name:
ABN:
Your phone number (please include area code):
Your mobile phone number:
Best time(s) to call:
Please send my quote by (select at least one):
email phone fax mail
Your email address:
Your website address:
Your fax number:
Your postal address:
Country: