About Your Building

Strata Plan No:
Address Of Premises:
Period Of Insurance:
From: To:
Previous Insurer:
Policy Number:
Type: ResidentialCommercialIndustrial
No Of Lots:
No Of Buildings:
Age Of Building/S:
No Of Floors:
Construction Of Floors:
Construction Of Walls:
Construction Of Roof:
Pool: YesNo
Elevator: YesNo
Building Sum Insured $:
Contents Insurance $:
Loss Of Rent $:
Public Liability $:
Office Bearers $:
Personal Accident $:
Machinery Breakdown $:
Other Insurances - Detail:
Workers Comp. Wage Est:
Premises Unoccupied: YesNo
No Of Units Vacant:

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Other details pertaining to proposal

None

Public liability claims history - If known

None - New development

5 year claims history - If known

Insurer / Date of Claim / Cause of damage / Amount

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