Regional Network Alliance (RNA)

Drones/UAV’s (Unmanned Aerial Vehicle) are becoming extremely popular in both the private and commercial sectors. Owning a Drone/UAV can be an enjoyable hobby or a useful tool for a business, however in both circumstances, operating such a device can present a number of unique risk factors.

Drone insurance risks are categorised into two sections; third-party property and personal injury risks; and the loss or damage to the drone equipment. Due to the rapid increase of Drone/UAV usage, the rules and regulations in Australia continue to change at similar rate. Honan’s insurance specialists can help you navigate the relevant regulations and tailor an appropriate solution to your circumstances. For further information, please call our team on (02) 9299 0767.

Private Motor Questionnaire

Private Motor Questionnaire
Contact name:*
Your Phone Number (including area code):*
Contact email address:*
Cover date required from:*
Name of each insured:*
DOB of each insured:*
Current insurer:*
Current excess:
Full comprehensive or third party only:*
Registration:
Model, body and make of vehicle:
Transmission type:
Engine size:
Market value or agreed value?:
If agreed, what amount:
Finance:
Last 5 years Claims History
Date of loss: Description: Amount paid:
Address parked overnight:
Overnight parking type:
Address parked during the day:
Daytime parking type:
Have you made any Insurance Claims in the last 3 years?:
Have you ever had any insurance refused, declined or cancelled by any insurer, or made subject to special conditions or had a claim denied?:
Have you had any criminal convictions (last 10 years)?:
Have you had any infringements other than parking fines in the last 5 years?:

Strata Claim

STRATA INSURANCE CLAIM FORM
Please complete the below fields, providing as much information as possible.

This will assist the insurer in processing your claim.
Insured Details
Insured Name and Plan Number:
Owners Corp Secretary details (name, email and phone number):
Full address where loss occurred (please list if common area or units have been affected):
Date of loss:
Policy number and name of Insurer:
Are you GST registered?:*
- Yes
- No
If yes, please provide your ABN number and ITC percentage:
Payment Details
Bank details must be provided below.
Account Name:
BSB:
Account Number:
Access Details
If an assessor is appointed, access to the premises may be required.

Please list the name and contact details of the relevant person who can facilitate access.
Contact name:*
Contact details (phone number and email address):*
Loss Details
Nature and detailed description of damage (details of loss):
Cost Details
*
Items claimed (e.g. make safe, repairs, etc.): Amount:
Quote/Invoice Attached?:*
- Yes
- No
Attachment:
Third Party Details
If the Loss was caused by malicious damage, impact damage, vandalism or theft, please complete this section.
Police report number (if applicable):
If you know the details of the responsible third party who caused the damage, please provide their details (name, address and phone number):
Declaration
I hereby declare that the information contained within this document is true and correct and I make this declaration on the basis that I have been delegated power to sign for and on behalf of the Owners Corporation.
Full Name:*
Signature:*
Date:*
Your Phone Number (including area code):*
If you have any queries, please contact us on 02 9299 0767.
*
I hereby declare the statement and particulars I make on the following page to be true and correct and I make this declaration on the basis that I have delegation of power to sign for and behalf of the insured.
Comments
This field is for validation purposes and should be left unchanged.

Landlord Claim

RESIDENTIAL LANDLORDS PROPERTY INSURANCE CLAIM FORM
Please answer all relevant questions and attach a separate sheet if more space is needed
PURPOSE
Name of Insured:*
Trading as:
Contact Person:*
Your Phone Number (including area code):*
Email address:*
Postal address:*
GST DETAILS
Is the insured registered for GST purposes?:*
- No
- Yes
If yes, provide insured’s ABN:
Has the insured claimed (or can claim) an input Tax Credit for the GST on your insurance policy?:*
- No
- Yes
If yes, provide the amount the insured intends to claim if less than 100%:
CLAIM DETAILS
(NB. You must report any loss, theft or vandalism to the police. We may need to apply for a copy of your report.)
Address where the loss/damage occurred:
Date of loss:
Brief description of what happened:
Is a third party responsible for the loss/damage (including a tenant)?:*
- No
- Yes
If yes, who?:
Please advise contact details, including that of any witnesses:
Were the police notified?:*
- No
- Yes
If yes, please provide the following details.
Police report number:
Police officers name:
Station:
Date:
What was the method of entry and exit to/from the premises?:
What other action was taken to reduce your loss?:
List of items lost, damaged or stolen
If you need more space, please attached a separate sheet showing the information below for each item.
*
Full description of each item lost, damaged or stolen: Month/Year Purchased or acquired: Original purchase price ($): Input Tax Credit you can claim as a % of the total GST: Amount ($) claimed:
Total:
Do you own the items listed?:
- No
- Yes
Provide details of any other interested party (e.g. Mortgagee):
A) If the damaged item is repairable, please attach two original quoted for repair
B) If the damaged item is unrepairable, attach the original receipt, valuation, quotes for replacement or certification from an authorised repairer that the item is unrepairable.
C) Photographs of the damaged property should also be supplied to us if available
LOSS OF RENT DETAILS
(Please attach the residential lease applicable to the claim)
Reason for loss of rent:
Name and contact address of tenant (or forwarding details if known):
Has the term set out in the original lease to the Tenant expired?:
- No
- Yes
Has the Tenant given you or your managing agent, notice of intention to vacate?:
- No
- Yes
If Yes, please attach a copy of the notice
Have notices to vacate been issued to the Tenant?:
- No
- Yes
If Yes, please attach a copy of the notice(s)
Has a claim been lodged with any Tenancy Tribunal?:
- No
- Yes
If Yes, please attach a copy of the claim(s)
What date did the Tenant move into the premises?:
What date did the Tenant vacate premises/return keys?:
Until what date has the tenant paid rent?:
Bond amount:
Has the Bond been claimed?:
- No
- Yes
If no, why not?:
Have the premises been re-let?:
- No
- Yes
If no, why not?:
If Yes, attach a copy of the new residential lease)
AMOUNT OF CLAIM FOR LOSS OF RENT
Date from:
Date to:
Weekly rental amount:
CLEANING AND RE-LETTING* EXPENSES SHOULD BE DEDUCTED FROM THE BOND AS FOLLOWS
PAYMENT DETAILS
Do you want payment to be made by electronic funds transfer?:
- No
- Yes
If Yes, provide the payee’s bank details
Bank name:
Bank Branch:
Account Name:
Account Number
BSB:
If no, who should the settlement cheque to be made payable to?:
Attachments:
Drop files here or
This claim is being made against Chubb Insurance Australia Limited ("Chubb") which may be contacted by calling 02 9273 0100 to receive information on the closest Chubb office. Chubb reserves the right to contact either the insured or Honan Insurance Group directly or indirectly to gather any further information Chubb may require as part of the claim review process. Any information provided to Honan Insurance Group or Chubb will be subject to Chubb's Privacy Policy, which may be found at www.chubb.com.
DECLARATION
(lf a firm / company, the following declaration must be made and signed by a member of the firm, so describing him self / herself) I/We declare that the above answers are true and correct to the best of my/our knowledge and that I/we have not withheld any relevant information that may affect the claim. I/we consent to Chubb Insurance Australia Limited using my personal information provided on this form for the purpose of processing my claim.
Signed:
Date:
Full name:
Position (if a firm/company):
For Office Use Only - To Be Completed By Honan Insurance Group
Policy number:
Period of Insurance:
Date Premium paid:
Print name:
I hereby declare the statement and particulars I make on the following page to be true and correct and I make this declaration on the basis that I have delegation of power to sign for and behalf of the insured.
Name
This field is for validation purposes and should be left unchanged.

1 Step 1 Your details

2 Step 2 Insured Property Details

3 Step 3 Sum Insured

Your details
Your Name:*
Postal Address:*
State:*
Postcode*
Your Email Address:*
Your Phone Number (including area code):*
Your Fax Number:

Insured Property Details
Owners Corporation Plan No. :*
Name of Insured:*
Address to be Insured:*
Suburb:*
State:*
Postcode:*
Current Insurer:
Excess ($) :
Due Date:
Year Built:*
If built before 1965, has the house been rewired / replumbed in the last 20 years?:*
No. of units:*
Storeys:*
Occupants:
Walls:*
Roof:*
Floors:*
Fire Protection:
- Hydrants
- Hose Reels
- Sprinklers
Security Protection:
- Deadlock
- Local Alarm
- Monitored Alarm
- Security Cameras
No. of lifts:
No. of pool / spas:
No. Gyms:
Professional Managed?:

Sum Insured
Building ($):*
Common Contents ($):*
Public Liability:
Voluntary Workers / Personal Accident ($):
Office Bearer Liability ($):
Fidelity Guarantee ($):
Machinery Breakdown ($):
Last 5 years claims history:
upload previous claim history via an attachment:
Drop files here or

Accepted file types: pdf, zip, jpg, gif, tif, png, bmp.
Additional Comments:*
Phone
This field is for validation purposes and should be left unchanged.

1 Step 1 Your details

2 Step 2 Insured Property Details

3 Step 3 Sum Insured

Your details
Your Name:*
Postal Address:*
State:*
Postcode:*
Your Email Address:*
Your Phone Number (including area code):*
Your Fax Number:

Insured Property Details
Owners Corporation Plan No.:*
Name of Insured:*
Address to be Insured:*
Suburb:*
State:*
Postcode:*
Current Insurer:
Excess ($) :
Due Date:
Year Built:*
If built before 1965, has the house been rewired / replumbed in the last 20 years?:*
No. of units:*
Storeys:*
Walls:*
Roof:*
Floors:*
Fire Protection:
- Hydrants
- Hose Reels
- Sprinklers
No. of lifts:
No. of pool / spas:
No. Gyms:
Professional Managed?:

Sum Insured
Building ($):*
Common Contents ($):*
Public Liability:
Voluntary Workers / Personal Accident ($):
Office Bearer Liability ($):
Fidelity Guarantee ($):
Machinery Breakdown ($):
Last 5 years claims history:
upload previous claim history via an attachment:
Accepted file types: pdf, zip, jpg, gif, tif, png, bmp.
Additional Comments:
Name
This field is for validation purposes and should be left unchanged.

1 Step 1 Your details

2 Step 2 Insured Property Details

Your details
Your Name:*
Postal Address:*
State:*
Postcode:*
Your Email Address:*
Your Phone Number (including area code):*
Your Fax Number:

Insured Property Details
Name of Insured:*
Address to be Insured:*
Suburb:*
State:*
Postcode:*
Type of Property:*
Mortgage:
Cover required from (date):
Year Built:*
Building Construction:*
- Brick
- Timber
Sum Insured ($):*
Last 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?:*
- Yes
- No
Additional 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:*
- Owner
- Property Manager
Name
This field is for validation purposes and should be left unchanged.

1 Step 1 Your details

2 Step 2 Insured Property Details

Your details
Your Name:*
Postal Address:*
State:*
Postcode:*
Your Email Address:*
Your Phone Number (including area code):*
Your Fax Number:

Insured Property Details
Name of Insured:*
Address to be Insured:*
Suburb:*
State:*
Postcode:*
Type of Property:*
Mortgage:
Cover required from (date):
Year Built:
Building Construction:*
- Brick
- Timber
Last 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?:*
- Yes
- No
Additional 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:*
- Owner
- Property Manager
Email
This field is for validation purposes and should be left unchanged.

NSW Small Business Stamp Duty Exemption Declaration
This declaration only covers policies for the financial year in which the cover is effected or renewed.
I hereby declare that I am a Capital Gains Tax small business entity (within the meaning of section 152-10 (1AA) of the Income Tax Assessment Act 1997 of the Commonwealth). I am a small business individual/ partnership/ company and/or trust, which is carrying on a business, and the business has an aggregated turnover of less than $2 million*.
SIGNATURE:*
NAME OF THE INSURED (PRINT):*
DATE:*
ABN OF INSURED:*
Your Phone Number (including area code):
EMAIL:*
*Aggregated turnover is your Australia wide annual turnover plus the annual turnovers of any business entities that are your affiliates or are connected with you.
*A fraudulent declaration may invalidate your insurance contract.
Comments
This field is for validation purposes and should be left unchanged.

Description of incident:	Date:	Amount paid:

Date of loss:	Description:	Amount paid:

Date of incident:	Description:	Cost:

Full description of each item lost, damaged or stolen:	Month/Year Purchased or acquired:	Original purchase price ($):	Input Tax Credit you can claim as a % of the total GST:	Amount ($) claimed:

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