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Quotation Request Form

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Step 1 of 7

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1. Your Details

DD slash MM slash YYYY
DD slash MM slash YYYY
Are you domiciled in Australia?*
Have you been declared bankrupt in the last 5 years?*
Have you Incurred any loss or damage, (whether insured or not), or had any claims made against you in the last 5 years?*
Had insurance refused, cancelled or had special terms or conditions imposed on an insurance policy in the last 5 years?*
Been charged with or convicted of a criminal offence in the last 10 years (other than traffic offences)?*

2. Risk Details

Address of property to be insured*
Is the property Heritage listed?*
Property type*
Property use*
Is the property*
If built before 1970, has the property been substantially renovated?*
If yes, please provide
Does the property have a basement?*
Does the property have a flat roof?*
Do the external walls or roof contain any of the following materials*
Is the property on town water?*
Is the property made available for short term/temporary letting?*
Is there any pre-existing or suspected pre-existing damage that you are aware of?*
Is the property structurally sound, watertight and well maintained?*
Is the property currently occupied?*
DD slash MM slash YYYY
Is the property used for any business purposes other than administrative work in a home office?*
To your knowledge, has the property or its grounds been affected by flooding, bushfire, wildfire or grassfire?*
Is the property undergoing any renovations, alterations or additions or are there any planned in the next 12 months?*
Does the home have deadlocks on all external doors?*
Does the home have key operated window locks on all accessible windows?*
Is the home protected by an intruder alarm?*
If monitored, what type?*
Does the home have a strongroom or safe?*
Is the safe*
Is the safe connected to the alarm*
Is there any additional security - e.g. electric gates, video entry, CCTV, window grilles, live-in staff, onsite security personnel, etc?*
Is the home protected by smoke detectors?*
If yes, what type?*

3. Home Cover

Note: Tenanted Properties If you regularly lease out the property on an unfurnished basis, please include the replacement value of carpets, curtains and internal blinds in the home sum insured.
Note: Tenanted Properties If you regularly lease out the property on an unfurnished basis, please include the replacement value of carpets, curtains and internal blinds in the home sum insured.
Excess*

4. Contents Cover

Note: Additions and alterations (strata properties only) Please provide the replacement value of internal paint work, wallpaper and any fixture or structural improvement pertaining to the unit which the Body Corporate is not required by law to insure.
Excess*

5. Private Collections

List of your collections
Title
Category
Value ($)
 

6. Additional Information

Are there any additional residential locations to be insured?*

About LuxGuard

LuxGuard Insurance Brokers is a wholly owned subsidiary of the IMC Insurance Group. Formed in 1994, IMC Insurance Brokers Pty Ltd (AFS Licence Number 229344) is a General Insurance Broker licensed by Australian Securities Investment Commission (ASIC) under the Corporations Act.
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Copyright 2025 © LuxGuard Insurance Brokers - a division of IMC Insurance Brokers, Level 1, 251 - 253 Malvern Road South Yarra VIC 3141 | 1300 754 232
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Report A Claim

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Insured Name*
Date of Loss
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