Strata Insurance Proposal Form 1 Your Details 2 About your Strata Plan 3 Insured Property Details 4 Cover Required 5 Declaration and Submit Introduction Please answer all questions in this proposal form. Blanks and/or dashes, or answers "known to underwriters or brokers" or "N/A" are not acceptable and will delay processing of this application. Any documents attached to this document form part of this application. Where appropriate, please tick the yes or no box which best indicates your reply. If you have any questions whilst completing this insurance proposal form, please call our office. Your Contact Details Your Name * Phone * Mobile Email * What is your relationship to the Strata Plan? * I am a member of the executive committeeI am a TenantI am a Licensed Strata ManagerI am a Family Member or Friend of someone who lives in the buildingI am a developer or builder - This is a new buildingI am a Lot Owner but I am not on the executive committeeOthers Previous Next Next, tell us about your Strata Plan Strata Plan Number/s * If you have a copy, please provide a copy of the relevant strata plans, Strata Management Statement (SMS) and Building Management Statement (BMS) Upload or drag files here. This isn’t compulsory - However, the more information you can provide to us, the better results we can obtain for you. Do you have any of the following reports or documents available: Building Valuation less than 3 yearsElectrical Thermographic ScanRoofing ContractorPlumbers ReportGeneral Building Maintenance or DefectRisk Management This isn’t compulsory - However, the more information you can provide to us, the better results we can obtain for you. Please upload a copy of your thermographic scans, risk management reports, roofing reports, plumbing reports, maintenance reports, valuations, or other supporting documents. Upload or drag files here. This isn’t compulsory – however, the more information you can provide to us, the better results we can obtain for you. What is the full address of the Property to be Insured? * Building Age & Levels Year property was first constructed Number of levels expressed as Ground Plus Number How is your property occupied? Residential (Owner Occupied)Residential (Owner’s Personal Use or Family Holiday Home)Residential (Rented to Tenant)Residential (Holiday Rental, Short Term Rental, Air BNB, Stayz)Commercial (Offices)Commercial (Retail)Commercial (Hospitality - Hotel, Cafe, Restaurant etc)Commercial (Other)Industrial (Factory Unit Bays)Other (Select all that apply) Previous Next About the Insured Location Building Facilities Number of lifts Number of pools Number of playgrounds Number of water features Number of jetties or wharves Number of gyms Number of tennis courts What type of air conditioning units are in place? —Please choose an option—Central or Ducted Air ConditioningN/AIndivival Units Are there any chillers or cooling towers? Are there any car stackers or turntables? Any other facilities? Construction Information What are the External Walls made of? Brick VeneerDouble Brick or Concrete BlockStoneConcrete Tilt SlabConcreteConcrete/Cement Rendered FinishFibro CementAsbestosHardi Plank (Cement Panels that look like timber panels)Weathertex (Fire Rated Modern Hardwood Timber Panels)TimberMudbrickColourbond, Zincalume or SteelAluminium Composite Panels (ACP)Other Sandwich Panel or Structural Insulated Panelling SystemOthers (Select all that apply) What is your roof covering made from ConcreteTerracotta TilesConcrete TilesMetal / Colourbond / ZincalumeAsbestosOther (Select all that apply) What type of Structural Flooring do you have? Concrete Ground FloorTimber Ground LevelMagnesite FlooringConcrete Upper Level(s)Timber Upper Level(s)Others (Select all that apply) Does the building have structural retaining walls? If so please confirm construction material Does your property have any Sandwich Panels, Insulated Panels, whether structural or non-structural on the property? YesNo For more information on Sandwich Panels, please visit – Chubb risk bulletin – aluminium composite panels Does the building contain any Asbestos? YesNo Is your property Heritage Listed? YesNo Fire Protection Please select the Fire Protection systems you have in place at this property Smoke Alarms fitted to each unit and common areasFire Extinguisher(s)Hose Reel(s)Fire Alarms / Fire PanelFire SprinklersFire Hydrant Access Points / BoostersOthers Cladding Materials Does the building have cladding? YesNo Further Details Does the property have any defects? —Please choose an option—YesNoUnknown Does the property have any outstanding fire orders? —Please choose an option—YesNoUnknown When was the last valuation on the property? Is a valuation planned in the next 12 months? —Please choose an option—YesNoUnknown Are you (or the body corporate) planning any renovations, alterations, construction or repairs that will exceed $100,000 in the next 12 months? YesNo Previous Next Sums Insured Building Sum Insured (BSI) Common Contents Sum Insured (CSI) Loss of Rent/Temporary Accommodation Is cover required for Internal floating floors? —Please choose an option—YesNoNot sure Is cover required for Internal paint or wallpaper? —Please choose an option—YesNoNot sure Liability —Please choose an option—$10,000,000$20,000,000$30,000,000$50,000,000Other (specify below) Fidelity Guarantee Voluntary Workers - Capital Benefits Voluntary Workers - Weekly Benefits Office Bearers' Liability —Please choose an option—YesNoIncluded in policyNot sure Machinery Breakdown Catastrophe Cover —Please choose an option—YesNoNot sure Government Audit Fees Appeal Expenses Legal Defence Expenses Lot Owners Fixtures & Fittings Is Flood Cover Required? YesNo Is Cyber Crime cover required? YesNo What is your preferred excess / deductible? You can elect a higher excess for a lower premium or a lower excess for a higher premium Standard Excess Water Claims – Storm (Rainwater) or Flood If you would like a different excess for Water Damage claims, please list this here Previous Next Insurance Claims History and your Duty not to Misrepresent Claims and Disclosure Questions The questions we ask below will help us arrange quotes for you, however, you will be required to check similar questions which may be worded differently on any final application form or 'what you told us' form before you make payment of any policy we arrange for you. You must check these forms that we send to you each and every year to ensure the answers remain accurate and notify us of any changes that are required. The Insurance History for your Strata Plan Please tell us who your current insurer is What is the renewal date (expiry date) of your current policy? When do you need your quote back to you by? In the past five years has any insurer: Declined to renew your policy against your wish —Please choose an option—YesNo Declined to accept your proposal —Please choose an option—YesNo Imposed special conditions on your policy —Please choose an option—YesNo Cancelled your policy against your wish —Please choose an option—YesNo Do you have a current claims history printout (document) showing all claims in the last 5 years? YesNo Claims History last 5 years Have you (or the body corporate) had any claims or suffered any loss that could have been claimed on this policy in the last 5 years? YesNo Unreported Claims or Damage Please list any damage or claimable circumstances that have not yet been reported to your current insurer Is there any Damage or are there any claims which are yet to be reported? Are you aware of any claim or circumstance that may give rise to a claim against a Strata Committee Member? —Please choose an option—YesNoUnknown Duty to not misrepresent Financial Service Guide (FSG) Our Financial Service Guide (FSG) explains who we are and the license under which we operate. You should read our FSG before accepting any policy or advice from us. You can read our FSG online at www.oraclegroup.com.au/fsg. Cooling Off If you are not completely satisfied with your policy, you may cancel it by notifying us in writing within 14 days of cover having commenced. You will receive a refund of the amount you have paid unless something has occurred for which a claim may become payable under the policy. Confirming Transactions You may contact us, in writing (which is always required if you are advising cancellation) or by phone, to confirm any transaction under your policy. Any transaction will be documented by us as quickly as possible. Code of Practice A self-regulatory Code of Practice exists for the general insurance industry, designed to raise overall standards. We have adopted the Code, details of which can be obtained from your insurance broker or our office. Complaints If you do not agree with any decision we make in relation to your insurance, please write to us stating what you disagree with and why. We will then either resolve or attempt to resolve your complaint immediately or refer the matter to our Internal Dispute Resolution Committee (IDRC). If you are not satisfied with a decision of the IDRC, the matter may be referred to the Australian Financial Complaints Authority (AFCA) if eligible. Privacy We respect your privacy and comply with the Privacy Act and the National Principles. A copy of our Privacy policy is available upon request or on our website. If you do not tell us something If any of your answers are misleading, incomplete, inaccurate or fraudulent we may reduce or not pay a claim, cancel your policy or treat it as if it never existed. Insert and format text, links, and images here. I hereby declare that: My attention has been drawn to the important notices accompanying this Application form and further I have read these notices carefully and acknowledge my understanding of their content by my signature below. The above statements are true, and I have not suppressed or mis-stated any facts and should any information given by me alter between the date of this Application form and the inception date of the insurance to which this Application relates I shall give immediately notice thereof. I authorise you to collect or disclose any personal information relating to this insurance to/from any other insurers or insurance reference service. Where I have provided information about another individual (for example, an employee, or client), I declare that the individual has been or will be made aware of that fact and the section in the Policy on “The way we handle your personal information”. I also confirm that the undersigned is authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this Application form and I complete this Application form on their behalf. Details of Person Completing this form Your Name Signature Your Position (i.e. committee member, strata manager etc) Date Previous Next
