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 Brokers National 

Brokers National offers a choice of Home & Contents policy covers                                           Either a "Standard Defined Perils" cover or an "Accidental Damage" cover                                                     Did you know that the premium is higher for an accidental damage policy?                                                 A "Standard" Policy offers the option to insure: Your Home Buildings, Your Contents, Your Personal Effects Away From The Home, & Specified Items Used Away From The Home                                             We look forward to assisting you with insurance on your home, contents, & personal effects

EMAIL Or FAX

On-Line Home & Contents Insurance Quote


Thank you for considering our on-line home & contents insurance quote service. Brokers National has accounts with most insurers and underwriting agencies. We aim to find you the best home & contents insurance deal possible.
Please fill in the following form - answering all questions, then either:

1. Click on "Email to Brokers National" at the bottom of this form.  OR                               

2. Highlight this form to "Print It" and then "Fax It" to our office on 03 9791 6633.


 Use the Mouse or the Tab key to move to the next field. We will respond with quotes as soon as they have been received from our insurers.

                                                HOME &/OR CONTENTS

About the property you wish to insure:

Postcode of property:
Approximate Age of house: years
Date of Birth of the oldest person at home:
Is that person retired? Yes    No
Is that person a pensioner? Yes    No
Construction pf home:
Current occupancy status:
Is the house on more than 1 acre of land? Yes    No
Is the house in Neighbourhood Watch area? Yes    No
  Is the house connected to town water? Yes    No
the value of insurance you are seeking:
Building sum insured: $
Contents sum insured: $

Extra protection for accidental loss or damage (this is an additional cost):

Unspecified Valuables:

 $

Specified Valuables:
  Art: $
Music: $
Jewellery: $
Photographic equipment: $
Bikes: $
Computers: $
Laptops/Phones: $
Excess you would prefer to pay on this policy:
(Excess is the amount you pay out of each claim you make)

Security information about the house:


Doors:
Are there deadlocks on all external doors? Yes   No
Do all sliding doors have patio bolts? Yes   No    No sliding doors


Windows:
Are there keyed locks on all windows? Yes    No
 Do any windows have bars? Yes    No    Details:


Other security information:
What kind of alarm system (if any) is present? Audible    Monitored  None
Is there a 1kg dry chemical fire extinguisher in the house? Yes     No
Are there smoke detectors in the house? Yes     No

Insurance history of the house:
Claims free years: years     Previous or current insurer:    
Due date of your current policy:     Premium payable $

Any other notes you wish to include:
 

Contacting you about your quote:

Please make sure you leave a contact phone number and the best time to call you.
Your Name:
Company Name:
Your Phone Number & Area Code:
Best Time(s) To Call:
Please send my quote by (select at least one): email     phone     fax     mail
Your Email:
Your Facsimile:
Your Postal Address:

Click On Email Quote To Send Form To Us
 

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