Application Form

First Name
As appears on the Building Permit or DA
Last Name
As appears on the Building Permit or DA
Construction or renovation site address:
Number Street
Town Postcode
Postal Address Email Address to Receive Quote:
Which of the following best describes your owner
builder project
Contact No:
Owner builder project value ($) Adding an extension or alterations or renovating,
do you wish to insure you existing structures?
No Yes
‘When renovating or adding to existing structures, owner builders should review their current home insurance to determine whether their insurer will continue to cover existing dwelling during the construction period. Most home insurance products do not provide seamless insurance cover between constructions works risks and existing dwelling risks which may severely expose an owner builder’
Limit of Public Liability required: ($)
Does this project involve any of the following or do any of the circumstances described below exist?
Works Which Has Progressed Beyond Slab Stage?
Yes No Note only if BEYOND slab or sub-floor stage
Works Which Has Progressed Beyond/past Lock Up Stage?
Yes No Only if BEYOND Lock Up which means every door and every window and every access point to the inside is secured under lock and key
Works Under, Over, in or Near Water (Within 10 Metres of Water eg. Dam, Lake, River etc) or Exposure to Flooding or Escape of Water?
Yes No
Work involving Piling, Shoring, Propping or Underpinning?
Yes No
Any Demolition Works Other than Hand Tool Demolition and Not Exceeding 5m Above Ground or 3m Below Ground Level?
Yes No
The owner builder will remove or work with Asbestos?
Yes No Select carefully, an Owner Builder is not authorised nor legally entitled to touch or remove this highly dangerous material. Engage only licenced and insured Contractors to remove Asbestos.
Work Involving House Raising, Restumping or Relocating?
Yes No
Works where any Structural Element has not been Designed or Supervised by a Structural Engineer?
Yes No
Labour Hire Risks?
Yes No Labour Hire Risk means recruiting an Independent Labour Hire Company to recruit workers to work on your construction site
Erection of Machinery or Plant (EAR Risks)?
Yes No Erecting cranes and heavy haulage lifting equipment or power plant equipment or radio/TV towers
Works Requiring Blasting? Yes No Risk Located Without Public Road Access? Yes No
Stand-alone Swimming Pool or Spa construction? Yes No Civil Risks include constructing tunnels, bridges, wharves, jetties, piers dams/reservoirs and weirs. Or constructing pipelines, roads and runways, underground risks, ocean outfalls/intake works, retaining walls (in excess of 3M), silos and towers. Yes No
Construction of Any Building or Structure Exceeding 3 Storey? Yes No Any Excavation Greater than 3m? Yes No
Work to Heritage Buildings or buildings over 120 years old?
Yes No Heritage Listed Residences requires special underwriting consideration. Heritage Overlay or environmental overlays also require a little extra care, so our underwriters will require additional information
Any works on the Boundary of the property? Yes No
Proposed work to any Shared or Common Walls? Yes No If Existing Structures insurance cover is selected, are these structures in disrepair, with no or little security against vandalism, malicious damage, squatters and fire risk?
Yes No Will the existing structures be unoccupied during the owner builder works and thereby likely to be vandalised, or occupied by squatters or uninvited visitors?
Have You in the past five (5) years:
Made any claim(s) on an insurance policy for loss or damage, individually or cumulative over $5,000? Yes No Had any insurance declined or cancelled, application rejected, renewal refused, claim rejected, special conditions or excess imposed by an insurer? Yes No
Suffered any loss or damage which would have been covered by this proposed insurance policy?
Yes No Have you made a claim against a construction insurance policy over the last 5 years?
Have you:
Ever been declared bankrupt? Yes No Ever been involved in a company or business which became insolvent or subject to any form of insolvency administration (eg Liquidation or receivership?) Yes No
Been convicted of any criminal offence within the past 5 years (Other than traffic convictions)? Yes No

The above information is true and correct and no information has been withheld
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