Moving Insurance

Moving Insurance - Booking

It is important that you complete the following form carefully. Specific information is required to properly respond to your request. Please review your selections before submitting the form. This will assist us in dealing quickly with your request.

Note: use the TAB key to move to the next field as you complete this form.

Insured Details

Our quotation # *
Insured name/s *
Contact first & last name *
Mobile phone
Phone Please include your area code
Fax Please include your area code
Email *

Cover Option

Cover A: This cover is only available when you have contracted a professional carrier to move your goods.

Cover B:This cover is available if you are moving your own goods or having them moved by a professional removalist.

Please see Policy Document/Product Disclosure Statement for further details.

Cover option required

Move Distance

Indicate if this move is statewide or interstate.

Moving From

From address *

Suburb *
State *
Postcode *
Expected moving date *

Moving To

To address *

Suburb *
State *
Postcode *
Expected arrival date *

Correspondence Address

Specify the address to use for correspondence *
Correspondence address (* if other)

Suburb (* if other)
State (* if other)
Postcode (* if other)

Moving And Packing Responsibilities

Will your contents be moved and/or packed by a professional removalist? If Yes, provide removalist details.
Name of removalist (* if yes)
Removalist address (* if yes)

Suburb (* if yes)
State (* if yes)
Postcode (* if yes)

Sum Insured Selection

Total replacement value of contents to be insured *

Valuation Guide

Storage & Storage Insurance

If your goods are being transferred to or via storage, please indicate so below. Note that storage insurance is optional.
Is storage required?
Storage insurance is only available if your goods are stored by you in a Professional Self Storage Location anywhere in Australia, OR if they are stored by your removalists at their Normal Storage Locations anywhere in Australia. If storage insurance is not required or not applicable, skip to the next section.
Is storage cover required?
Expected From date (* If storage cover is required.)
Expected To date (* If storage cover is required.)
Region (* If storage cover is required.)
Specify the storage address (* If storage cover is required.)
Storage address (* If storage cover is required and storage address is other than REMOVALIST address.)

Suburb (* If storage cover is required and storage address is other than REMOVALIST address.)
State (* If storage cover is required and storage address is other than REMOVALIST address.)
Postcode (* If storage cover is required and storage address is other than REMOVALIST address.)
Total replacement value of goods to be stored (* If storage cover is required.)

Duty Of Disclosure

Before You enter into this insurance contract with Us for the first time, the Insurance Contracts Act 1984 requires You to provide Us with the information We need to enable Us to decide whether and on what terms Your Proposal for insurance is acceptable and to calculate how much premium is required for Your insurance. You will be asked various questions when You apply for this Policy. When You answer these questions, You must: •give Us honest and complete answers; •tell Us everything You know; and •tell Us everything that a reasonable person in the circumstances could be expected to tell Us. You do not need to tell Us about any matter: •that diminishes Our risk; •that is of common knowledge; •that We know or should know as an insurer; or •that We tell you We do not need to know. Who does the duty apply to? Everyone who is insured under the Policy must comply with the relevant duty. What happens if You or they breach the duty? If You or they do not comply with the relevant duty, We may cancel the Policy or reduce the amount We pay if You make a claim. If fraud is involved, We may treat the Policy as if it never existed and pay nothing. Duty on renewals, variations and reinstatements: A different duty applies for any variation or renewal or reinstatement of the Policy. Please refer to Your Policy Document for this duty. Duty of disclosure details are available on the Policy Document/Product Disclosure Statement (PDF)
Please disclose any matter that you need to disclose to us in accordance with your duty of disclosure.
If you do not have any matters to disclose, please tick box.
Duty of disclosure details

Tax Invoice [optional]

Business name for receipt
Business address for receipt

Payment

Your payment preference

Declaration

I/We Have read the Policy Document/Product Disclosure Statement. State that the information given in this application and any attachment to it is true and correct. Agree that this application and accompanying documents or papers shall form or partly form the basis of any Policy entered into. This application is completed on my own behalf and if not the only insured, on behalf of all other insureds.
Select I AGREE to indicate your acceptance of these terms and conditions.
Dated	07/01/09
* Indicates a mandatory field.