House Insurance - City Rural Insurance Brokers Adelaide

For more information, contact us by phone, email, or using our online form below.

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.

Applicant 1
Name*
First Last
Date of Birth*

Day
Month
Year
Over 55 & Retired?*
- Yes
- No
Home Phone*
Work Phone
Address*
Street Address Address Line 2 City State Postcode
Postal Address same as above or
Street Address Address Line 2 City State Postcode
Email*
Fax
Preferred Method of Contact*
Applicant 2
Name
First Last
Date of Birth

Day
Month
Year
Over 55 & Retired?
- Yes
- No
Email
Fax
Important
Current Insurer
Expiry Date

Day
Month
Year
Policy Cover
Please indicate if you have an ABN attached to the property
- Yes
- No
Sum Insured
Is your property under 5 acres?
- Yes
- No
Year of construction*
Size of property
If over 50 years old: Rewired
- Yes
- No
Date

Day
Month
Year
If over 50 years old: Replumbed
- Yes
- No
Date

Day
Month
Year
If over 50 years old: Reroofed
- Yes
- No
Date

Day
Month
Year
Part 1
Building (Replacement Value - $)*

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

If Building Only, enter 0
Specified Valuables in the Home*
- Yes
- No
(Any 1 item worth over $1000)
Item $
Part 2
Personal Valuables (Covered when outside the Home Property)*
- Yes
- No
Item $
Unspecified Items
- Yes
- No
Sum Insured
Insured Property Details
Dwelling Type*
Built on*
Number of Bathrooms/ensuites*
Number of Bedrooms*
Occupant type*
Construction*
Roof*
Other:
Floors*
Other:
Storeys*
Fire Protection
- Yes
- No
Burglary Protection
Deadlocks on all external Doors*
- Yes
- No
Back to Base Alarm*
- Yes
- No
Keyed window Locks on all windows*
- Yes
- No
Local Alarm System*
- Yes
- No
Bars or grills on all accessible windows*
- Yes
- No
Is the property on more than 10 acres?*
- Yes
- No
Electronic Surveillance key or card to common areas*
- Yes
- No
Is the property used for Business use?*
- Yes
- No
What type of business?
Live in Manage / Caretaker*
- Yes
- No
Is the property occupied*
- Yes
- No
Safe or other system*
- Yes
- No
Please describe
Will the home be unoccupied more than 60 days*
- Yes
- No
Interested Party
Mortgagee Name
Address
Street Address Address Line 2 City State Postcode
Has any insurer in respect of any insurance policy held by you, your partner...
Refused to renew/ cancelled or terminated a policy?*
- Yes
- No
Refused a claim or required an increased premium under the policy?*
- Yes
- No
Imposed special conditions under the policy?*
- Yes
- No
Have you been convicted any criminal offence or been declared bankrupt?*
- Yes
- No
Have you had any Claims in the past 5 years?*
- Yes
- No
If yes to any of the above, please give details below
eg date, description, insurer, and value of claim
Any additional information
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.*
- Yes
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Applicant 1

Applicant 2

Important

Sum Insured

Part 1

Part 2

Insured Property Details

Burglary Protection

Interested Party

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

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