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Strata Application Form  
Insured Details
Insured Due Date
Situation of Insured Property
Mailing Address
Property Details
No. of Units No. of Lifts No.of Pools
No. of Levels Year Built Sprinklers (Yes/No)
No. of Playgrounds No. of Water Features No. of Jetties/Wharfs
Wall Construction Floor Construction Roof Construction
Cover Required
Building/s and Common Contents (Please specify limit)
Additional Loss of Rent (Please specify limit – Note: 15% automatically provided)
Additional Catastrophe Cover (Please specify limit – Note: 15% automatically provided)
Public Liability (Please specify limit)
Fidelity Guarantee ($50,000 standard limit)
Office Bearers Liability (Please specify limit)
Voluntary Workers/Personal Accident ($100,000/$1,000 standard limit)
Machinery Breakdown (Please specify limit and attach details)
Workers Compensation (As per Statutory Legislation NSW & WA)
Duty of Disclosure Details
Have you had any claims in the last 3 years? (If yes, please attach details) YesNo
Has the insurance on this risk ever been declined or had special terms imposed? (If yes, please attach details) YesNo
Is the premises occupied? YesNo
Is any portion of the building occupied for commercial purposes? (If yes, please attach details) YesNo
Are there any hazards/defects associated with the property? (If yes, please attach details) YesNo
Current Insurer Current Excess
Your Details
Mr / Mrs / Miss / Ms First Name Current Excess
Job Title
Telephone Facsimile
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