As this is one of the largest investments a person may make it is important to correctly insure both your home building as well as the contents of your property. The two cover options (Defined Events or Accidental Damage) vary in what is and what isn’t covered, the wrong choice between them can be costly in the event of a claim. If you are unsure of the cover that may best suit you, please contact us.

In order for City Rural Insurance Brokers to provide you with an Obligation Free Quote, please complete the following.

Applicant 1

Name *

Date of Birth *

Over 55 & Retired? *

Home Phone *

Work Phone


Postcode *

Postal Address same as above or




Preferred Method of Contact * -

Applicant 2


Date of Birth

Over 55 & Retired?

Home Phone

Work Phone




Current Insurer

Expiry Date

Policy Cover

Sum Insured

Size of Building (sqm)

Age of Building*


Part 1

Building (Replacement Value - $)*
If Contents Only, enter 0

Content (Replacement Value - $) *
If Building Only, enter 0

Specified Valuables in the Home* (Any 1 item worth over $1000)

Item 1


Item 2


Item 3


Item 4


Item 5


Item 6


Item 7


Item 8


Item 9


Item 10



Part 2

Personal Valuables* (Covered when outside the Home Property)

Specified Items (If you chose 'Yes' above)

Unspecified Items

Sum Insured

Domestic Workers

Number of workers


Landlords Insurance

Weekly rental

Malicious Damage By Tenant


Tenant Rent Default


Insured Property Details

Dwelling Type*


Occupant Type*


Fire Protection




Has any insurer in respect of any insurance policy held by you, your partner...

  1. Refused to renew/ cancelled or terminated a policy?*
  2. Refused a claim or required an increased premium under the policy?*
  3. Imposed special conditions under the policy?*
  4. Have you been convicted any criminal offence or been declared bankrupt?*
  5. Have you had any Claims in the past 5 years?*

Duty of Disclosure

In order to make an informed assessment of the risk and calculate the appropriate premium, your insurer needs information about the risk you are asking it to insure.

For this reason, before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 to disclose to your insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer’s decision whether to accept the risk and, if so, on what terms. The duty also applies when you renew, extend, vary or reinstate a contract of insurance.
You do not have to disclose anything that:

  • Reduces the risk to be undertaken by the insurer;
  • Is common knowledge;
  • Your insurer knows, or in the ordinary course of its business, ought to know; or
  • If the insurer has waived your obligation to disclose.

If you do not comply with your duty of disclosure, your insurer may be entitled to reduce its liability in respect of a claim or may cancel your contract of insurance. If the non-disclosure was fraudulent, the insurer may be able to avoid (or cancel) the contract of insurance from its beginning. This would have the effect that you were never insured.

One important matter to be disclosed is the history of losses suffered by the person seeking insurance or any closely associated person or entity. As you are responsible for checking that you have made complete disclosure, we suggest that you keep an up to date record of all such losses and claims.

I have read the Duty of Disclosure above. *