Landlords Home & Contents Needs Analysis
Insurance for Home Building and/or Home Contents

CLIENT CONTACT DETAILS
Client Name:
(Remeber to provide full insured details)
Client Code:
Mailing Address:
Contact Phone No.: Contact Fax :
Email Address:
Referral Source:

BUYING MOTIVES?
To enable us to provide you with the most appropriate insurance product to meet your requirements we need to ascertain what you are looking for when you are considering your home and contents insurance:
The cheapest policy available as features and benefits do not concern you
The best cover available so I am covered for as many things possible
Combination cheap price & broad policy making sure of "value for money"
I want to be able to contact my broker as relationship is important to me
I want someone to look after any claims that occur & assist with the process
 
ABOUT THE PROPERTY
What is the address of the property to be insured?
Is there any Finance over the property? (please provide full financiers name)
If you answered "Yes" for Finance;
Do you have adequate Life Insurance to protect your asset and payout the mortgage if something happens to you? YES NO
If you answered "No" for Adequate Life Insurance; Can we get our business partner to contact you to review your personal protection? YES NO
Age of the building OR year building was built:
Is the property Heritage listed? YES NO
Is the property and any renovations or extensions council approved? YES NO
If not, please provide details:
What is the size of the property? (i.e. 800m2 or 5 acres or 100 hectares)
Is the property serviced by town water? YES NO
Has the property been re-plumbed if it is over 75 years old? YES NO
Has the property been rewired if it is over 25 years old? YES NO
Has the property been re-stumped if it is over 50 years old? YES NO
Does the property have a pool? YES NO
Does the property have a tennis court? YES NO
Does the property have a pontoon? YES NO
Is the building located in an area that has established Neighbourhood Watch? YES NO
Has the property experienced damage from a flood previously? YES NO
Is the property in close proximity to a river, lake, canal, or water course? YES NO
If so, how close:
Type of building:
If Other, please specify:
Occupant details:
If Other, please specify:
What are the outside walls of the building made of?
If Other, please specify:
Does the building include a glass enclosure such as a conservatory or green house? YES NO
Note: Some policies exclude glass breakage to conservatories and green houses.
Is a Business Activity carried on from the building?
(A business activity is an activity from which income is derived). 		YES NO
If Yes, what is the nature of the business:
(NOTE: There is no cover for Business Liability as a seperate policy must be taken out.)
Will the public be invited onto the premises? YES NO
For GST purposes, do you claim an input tax credit (ITC) for home and contents insurance costs? YES NO
If Yes, what percentage of ITC its claim?: %
Do you employ anyone to assist with domestic duties?
(If Yes, you may have a liability to protect the employee against injury that may occur while they are working for you. Your liability can be protected by a domestic workers compensation insurance policy.)
YES NO
Do you require a domestic workers compensation insurance policy? YES NO
If Yes, how many domestic workers do you employ?
Please advise your date of birth. If the policy is to be issued in joint names, advise the date of birth of the eldest person:
Are you retired from full-time work? YES NO
Is the person in whose name the policy will be issued to a pensioner? YES NO
 
INSURANCE HISTORY
Have you claimed on a House & Contents Policy in the last 5 years? YES NO
If so, please advise details (date, type of claim, amount of claim):
Have you ever been declined, cancelled, refused or special terms imposed? YES NO
Have you ever been convicted of any offense for property, fraud, theft, drugs or dishonesty? YES NO
 
WHAT TYPE OF COVER IS REQUIRED?
Defined Events This covers specific events that are listed in the policy like Fire, Storm (incl. Hail & Cyclone), Malicious Damage, Impact by car or plane, Earthquake, Water Leakage, Lightning, Burglary, or Theft and others. There are of course exclusions to every Home & Contents policy and you should refer to the PDS to review these.
Accidental Damage This policy acknowledges all of the events listed in the normal Defined Events policy as well as covering any Accidental Loss and/or Damage that is not otherwise excluded by the normal exclusions of the policy and you should refer to the PDS to review these.
Do you require cover for FLOOD? (This is the inundation of normally dry land from a natural watercourse, lake, river, dam or canal) NOTE: This definition can change between insurers so please refer to the PDS. YES NO
Do you require cover for RENT DEFAULT & TENNANT DAMAGE? (This covers rent loss where a tennant leaves without notice as well as damage caused by tenants which is normally excluded from a standard home insurance policy. NOTE: The definition can change between insurers so please refer to the PDS. YES NO
 
WHAT IS THE AMOUNT OF COVER THAT YOU REQUIRE?
Property to be insured Amount of cover Comments
Buildings: (incl. all outbuildings, in ground pools & driveways etc.) $ The cover is based on replacement and reinstatement. This means the building is reinstated as new, provided the amount the building is insured represents the replacement cost.
Unspecified Contents: $ The cover is based on replacement and reinstatement. This means the contents are reinstated as new, provided the amount the contents are insured represents the replacement cost.
Antiques: $ Most insurance policies that cover Home Contents, contain maximum amounts that the insurer will pay for specific items of contents, such as:
Works of art, pictures, tapestries, antiques;
Bicycles;
Cash, savings cerficatees, stamps, money orders and other negotiable instruments, bullion or documents.
The value of these items should be listed separately.
Jewellery: $
Video camera: $
Bicycle(s): $
Portable computer: $
Mobile phones: $
Other specified items: $
  $
  $
  $
Personal Liability: $ Minimum recommendaton of $10,000,000
Loss of Rent (weekly): $  
Personal Valuables - specific items of contents can be insured separately and be covered outside of the home. Items such as jewellery, watches, camera, mobile phone, etc. can be insured as special risks. This insurance will provide 24 hour cover, 7 days a week anywhere in Australia. An additional cost will apply for this cover.
Do you require an unspecified cover? YES NO
  • $1,000 per item with a total claim per year of $5,000
Yes
  • $2,000 per item with a total claim per year of $10,000
Yes
Do you require special risks cover? YES NO
If Yes, provide details of the items and amount to be insured:
1. - $  
2. - $  
3. - $  
Advise the types of security that have been installed:
Windows:
Standard Locks Keyed Locks Security Screens Bars/Grill
Doors:
Standard Locks Single Key Deadlock Double Key Deadlock  
Other:
Local Alarm Monitored Alarm Bolts on Sliding Doors Safe
Provide additional comment relating to security if required
Is this quote for the renewal of an existing insurance policy? YES NO
If yes, please advise the name of the current insurer, the policy number and expiry date of the current policy:
Current Insurer:
Policy Number:
Expiry Date:
This Needs Analysis was prepared by on / /
  
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OFFICE USE ONLY
WHAT ADVICE ARE YOU GIVING?
To enable us to provide you with the appropriate insurance product to meet your circumstances, financial objectives and needs we require certain information from you. In doing so, you have
Agreed to provide the following information about your circumstances, objectives and needs.
Asked that only certain needs were considered as stated.
Chosen not to complete the Needs Analysis or did not provide all of the information as requested.
Asked that information previously collected be used including amendments agreed. The information remains relevant and up to date.
General advice only.
COMPLIANCE
Have you advised the client of the PRIVACY ACT? YES NO
Have you advised the client of the DUTY OF DISCLOSURE? YES NO
Have you advised or provided the client of our FINANCIAL SERVICES GUIDE? YES NO
Did you provide a PRODUCT DISCLOSURES STATEMENT (verbal or document)? YES NO
If so what date was it provided? / /
 
Our firm will use this information to make certain recommendations to you so the information provided must be specific and correct otherwise it could affect the outcome of the advise we provide.