Landlord Contents Only Insurance - Get a Quote 1 Step 1 Your details2 Step 2 Insured Property Details Your detailsYour Name:*Postal Address:*State:*VictoriaNew South WalesAustralian Capital TerritoryQueenslandTasmaniaSouth AustraliaNorthern TerritoryWestern AustraliaPostcode:*Your Email Address:* Your Phone Number (including area code):*Your Fax Number: Insured Property DetailsName of Insured:*Address to be Insured:*Suburb:*State:*VictoriaNew South WalesAustralian Capital TerritoryQueenslandTasmaniaSouth AustraliaNorthern TerritoryWestern AustraliaPostcode:*Type of Property:*Mortgage:Cover required from (date): Year Built:Building Construction:*BrickTimberLast 3 years claims history:upload previous claim history via an attachment:Accepted file types: pdf, zip, jpg, gif, tif, png, bmp.Have you had any insurance refused, declined or cancelled by an insurer, or made subject to special conditions?:*YesNoAdditional Comments:Before you enter into a contract of general insurance with an insurer, you must disclose to the Insurer every matter that you know, or could reasonably be expected to know, that is relevant to the insurer’s decision whether to accept the risk of the insurance, and if so on what terms. You must provide accurate information and not misrepresent the nature of the risk to be insured. The duty also applies also when you seek to renew, extend, alter or reinstate a policy. It applies up to the time the policy is entered into, renewed, altered or reinstated. Your duty, however, does not require you to disclose matters: that diminish the risk to be undertaken by the insurer, that are of common knowledge, that your Insurer knows or ought to know in the ordinary course of their business, as to which compliance with your duty is waived by the insurer. If you do not comply with your duty of disclosure, the insurer may be entitled to reduce their liability under the contract in respect of a claim and/or cancel the contract. If your non-disclosure is fraudulent, the Insurer may decline the claim and may avoid the contract from its beginning. By submitting this form, you confirm that as Owner/Property Manager (please indicate below), you are authorised to make all required statements and disclosures required to be made to Chubb pursuant to the Insurance Contracts Act 1984 on the Insured’s behalf and that Chubb may rely upon those statements and disclosures for the purpose of determining whether it wishes to provide the requested insurance cover. Furthermore, you are authorised to execute and confirm the disclosures and representations made in this Application Form are correct. If required by Chubb, you will provide such documentation, including written confirmation of my authority to provide this declaration, as Chubb may require to determine if it wishes to provide the requested insurance cover. You also certify that: This rent is not currently in arrears nor is there any reason to believe that the rent will fall into arrears in the future You are not aware of any pre-existing damage You authorise your Agent/Property Manager to deduct the applicable insurance premium Please provide your full name:*Date:* I am the:*OwnerProperty ManagerNameThis field is for validation purposes and should be left unchanged.