Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Do you currently have insurance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you arranged insurance with us before? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
I am looking for: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
I would like a quote for: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Property Information

Please tell us more about the property you are looking to insure:

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Who currently lives at this property? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you know when this house was built? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Does your property have a joint or separate self contained unit? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

This is an estimated reconstruction cost as a result of a severe event (earthquake, flooding, fire) and should include fees associated with services like demolition and debris removal.  You can calculate it here. 

Has the property ever been affected by any natural disasters (flooding, landslides, earthquakes) or is it located in an area prone to these events? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
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Is your property free-standing or attached to an existing building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Is the property a part of a body corporate? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Does the property have a security alarm? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Is this property used for any form of business? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you made a claim on this property in the last 3 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Is there a mortgage on this property? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Contents Insurance

Do you have any specified items you'd like to insure? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Please provide the value of the items to ensure you're fully covered. Any jewellery will require an official valuation.  

{ binding firstError.message }
Have you made a contents claim in the last 3 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Individual, Couple or Family Trust

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Contents Insurance Only

Address where the contents is located {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Where is the contents stored? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Does the property have a security alarm? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Has the property ever been affected by any natural disasters (flooding, landslides, earthquakes) or is it located in an area prone to these events? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Do you have any specified items you'd like to insure? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Please provide the value of the items to ensure you're fully covered. Any jewellery will require an official valuation.  

{ binding firstError.message }
Have you made a contents claim in the last 3 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Motor Vehicle Information

Will this vehicle be used for any commercial purposes? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

If you plan on using this vehicle for commercial purposes, please refresh this form and select "Business Insurance" 

{ binding firstError.message }

To learn more about the types of cover, click here.

Do you know your vehicle registration details? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Please tell us a bit about your car:

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Has this vehicle been modified? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please provide the address where the vehicle will be/is parked majority of the time. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Driver Information

Will there be any drivers under 25 years old driving this vehicle? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Listing under 25 drivers will attract a lower excess and a higher premium, but not listing under 25 drivers will attract a higher excess but lower premium.

Do you want to list any drivers under 25 years old on this policy? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you want to exclude ALL drivers under 25 years old from this policy? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please include all drivers in the sections below

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{ binding firstError.message }
{ binding firstError.message }
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If you've selected "International Licence", please confirm the country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Is there a secondary driver? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Are there any additional drivers? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Secondary Driver Details
{ binding firstError.message }
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{ binding firstError.message }
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If you've selected "International Licence", please confirm the country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Additional Driver Details
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
If you've selected "International Licence", please confirm the country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
If you've selected "International Licence", please confirm the country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
In the last 3 years, have any of the drivers to be covered under this policy, experienced any accident or theft of a vehicle? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
In the last 3 years, have any of the drivers to covered under this policy, had a driving licence suspended, revoked or special conditions imposed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Is the vehicle currently financed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Health and Life Insurance

Please download a form below and email it to enquiry@sit.co.nz

Health and/or Life Insurance with AIA

Health Insurance with Southern Cross

 

Life Insurance with Fidelity Life

 
If you'd like to learn more about the different providers, give us a call on 64-9-525-3232.
{ binding firstError.message }
I would like a quote to insure my: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Building Information

Where is your building located? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Are you the sole owner of the building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you know the age of the building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
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Who is currently tenanting the building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Are there any hazards on-site? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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e.g. deep-fat frying, welding or spray-painting? 

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Have you made any claims on the property in the last 5 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Material Damage

Do you have a current insurance valuation for your building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{{ Cognito.resources['fileupload-dropzone-message'] }}
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Building Protection Information
What security protection does your building/business have? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What fire protection does your building/business have? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Business Interruption

Do you know the rates for your building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Liability

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_

Business Information

Is the business address the same as above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Where is your business located? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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These activities are a part of your revenue stream.

Does your landlord or another party require you to have insurance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Material Damage

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Is any of your stock refrigerated? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Business Interruption

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Liability

Please answer these questions to the best of your ability.

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Is there any additional cover that you think you may require? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you made any claims in the last 5 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Commercial Vehicle

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Vehicle Details

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Driver History

In the last 5 years, has any person who is likely to drive the insured vehicle: 

Ever been charged with any breach of regulations relating to work time driving hours or log book rules? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Had any convictions or had any penalties imposed for driving under the influence of alcohol or drugs? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Had a driver's licence cancelled, suspended or restrictions imposed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Been convicted or charged with any driving offences or issued any speeding or traffic infringements (other than parking offences)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Optional Extensions

In the event of a significant loss to the use of the vehicle.

Do you require cover for a rental vehicle? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you made any claims in the last 5 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Duty of Disclosure

I have read and accept the terms of the Duty of Disclosure Agreement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Duty of Disclosure Agreement can be found here. 

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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you currently have insurance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you arranged insurance with us before? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I am looking for: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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I would like a quote for: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Property Information

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Who currently lives at this property? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you know when this house was built? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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If "Yes", please enter a year below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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What is the floor area of your property? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Does your property have a joint or separate self contained unit? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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How much would you like to insure your house for? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Has the property ever been affected by any natural disasters (flooding, landslides, earthquakes) or is it located in an area prone to these events? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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If "Yes", please provide more details below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Is your property free-standing or attached to an existing building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Is the property a part of a body corporate? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Does the property have a security alarm? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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If "yes", please select an option below {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Is this property used for any form of business? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Have you made a claim on this property in the last 3 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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If "Yes", please specify below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Is there a mortgage on this property? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Who is your mortgage provider? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Click here if you're also interested in insuring the contents of this property. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Contents Insurance

Do you have any specified items you'd like to insure? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "yes", please specify below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
How much would you like to insure your contents for? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Have you made a contents claim in the last 3 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "yes", please specify below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Please confirm the name of the Policy Holder. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Please confirm the DOB of the oldest Policy Holder {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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When would you like your policy to take effect? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Contents Insurance Only

Address where the contents is located {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Where is the contents stored? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Who uses the contents? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Does the property have a security alarm? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If "yes", please select an option below {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Has the property ever been affected by any natural disasters (flooding, landslides, earthquakes) or is it located in an area prone to these events? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If "Yes", please provide more details below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you have any specified items you'd like to insure? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "yes", please specify below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
How much would you like to insure your contents for? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you made a contents claim in the last 3 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "yes", please specify below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
When would you like your policy to take effect? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Motor Vehicle Information

Will this vehicle be used for any commercial purposes? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Type of cover {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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To learn more about the types of cover, click here.

Do you know your vehicle registration details? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Car Registration No. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please tell us a bit about your car:

Year of Manufacture {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Vehicle Make {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Vehicle Model {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Engine Rating (CC) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Has this vehicle been modified? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
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What is the market value of this vehicle? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Please provide the address where the vehicle will be/is parked majority of the time. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Where on the property will this car be parked? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Driver Information

Will there be any drivers under 25 years old driving this vehicle? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Listing under 25 drivers will attract a lower excess and a higher premium, but not listing under 25 drivers will attract a higher excess but lower premium.

Do you want to list any drivers under 25 years old on this policy? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Do you want to exclude ALL drivers under 25 years old from this policy? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Please include all drivers in the sections below

Main Driver {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Licence Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "International Licence", please confirm the country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Is there a secondary driver? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are there any additional drivers? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Secondary Driver Details
Secondary Driver {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Licence Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "International Licence", please confirm the country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Additional Driver Details
Additional Driver Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Licence Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "International Licence", please confirm the country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Additional Driver Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Licence Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "International Licence", please confirm the country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
In the last 3 years, have any of the drivers to be covered under this policy, experienced any accident or theft of a vehicle? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
In the last 3 years, have any of the drivers to covered under this policy, had a driving licence suspended, revoked or special conditions imposed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Is the vehicle currently financed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
When would you like your policy to take effect? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Health and Life Insurance

Please download a form below and email it to enquiry@sit.co.nz

Health and/or Life Insurance with AIA

Health Insurance with Southern Cross

 

Life Insurance with Fidelity Life

 
If you'd like to learn more about the different providers, give us a call on 64-9-525-3232.
{ binding firstError.message }
I would like a quote to insure my: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Building Information

Where is your building located? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are you the sole owner of the building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Do you know the age of the building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If "yes", please enter a year below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Who is currently tenanting the building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please describe what the business activities: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are there any hazards on-site? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "yes", please specify below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you made any claims on the property in the last 5 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "yes", please specify below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Material Damage

Do you have a current insurance valuation for your building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you have selected "yes" and have this available, please upload the file here. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
What is the replacement value of your building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Building Protection Information
What security protection does your building/business have? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If you've selected "other", please specify below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
What fire protection does your building/business have? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If you've selected "other", please specify below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Business Interruption

Do you know the rates for your building? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
How much is your annual rent? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Liability

How much public liability do you require? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
How much statutory liability do you require? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

_

Business Information

Is the business address the same as above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Where is your business located? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
What is your business occupation? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please provide more information about the business activities? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Does your landlord or another party require you to have insurance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Material Damage

How much would you like to insure your contents for? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
How much would you like to insure your stock for? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Is any of your stock refrigerated? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "yes", please specify the percentage of the stock amount listed above. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Business Interruption

What is your gross profit for the year? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Liability

Please state the number of staff or people you employ? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
What is your estimated turnover this year? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
How much public liability cover do you require? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
How much statutory liability cover do you require? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
How much employer's liability cover do you require? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Is there any additional cover that you think you may require? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "yes", please provide some extra detail below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you made any claims in the last 5 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "yes", please provide more details below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Commercial Vehicle

What is your business occupation? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
What is the main commercial purpose of this vehicle? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Vehicle Details

Type of cover {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
How much would you like to insure the vehicle for? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Year {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Make {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Model {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Body Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Registration No. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Area of Operation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Driver History

Ever been charged with any breach of regulations relating to work time driving hours or log book rules? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Had any convictions or had any penalties imposed for driving under the influence of alcohol or drugs? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Had a driver's licence cancelled, suspended or restrictions imposed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Been convicted or charged with any driving offences or issued any speeding or traffic infringements (other than parking offences)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Optional Extensions

Do you require cover for a rental vehicle? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Maximum Time Period for Loss of any Vehicle {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Maximum Cost to Hire Per Day {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Have you made any claims in the last 5 years? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If you've selected "yes", please provide more details below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Duty of Disclosure

I have read and accept the terms of the Duty of Disclosure Agreement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }