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Landlord & Building | Vacant Land Insurance - Landlord Select

Landlord Insurance policy protects your investment property against tenant–related risks including loss of rental income and loss or damage by tenants.

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1300 667 507

Landlord Legal Expenses

Applicant Details

Your full name(Required)

First Last

Your contact details(Required)

Street Address City State Postcode Country

Telephone number(Required)

Email address(Required)

Are You eligible to claim an input tax credit on Your Premium?(Required)

Yes

No

What is/are the address/adressess of the Properties to be insured?(Required)

Street Address City State Postcode Country

Other Insurances

Please confirm whether You have existing private legal expense insurance.(Required)

Yes

No

If ‘Yes’ state with whom and the renewal date.

Have You ever been refused any insurance cover?(Required)

Yes

No

If ‘Yes’ please provide details.

Have You ever had any claim under a legal expense policy accepted, refused or declined in the last 5 years?(Required)

Yes

No

If ‘Yes’ please provide details.

Please confirm whether you have any insurance cover under another insurance policy for any of the insured events?(Required)

For example, consider Your home contents insurance or motor vehicle insurance.

Yes

No

If ‘Yes’ state with the name of Your insurer, policy number and the renewal date.

You have entered into written tenancy agreements in respect of each of the properties to be insured.(Required)

Yes

No

If ‘Yes’ please attach a copy of each agreement.

Max. file size: 8 MB.

General Information

Start/renewal date.(Required)

When would you like your cover to start?

DD slash MM slash YYYY

Please state the limit of indemnity you require.(Required)

The standard policy limit of indemnity is $50,000 for any one claim. You can also take an $100,000 limit for any one claim. Please choose the limit that you require. The maximum limit of indemnity is $150,000 aggregate limit per period of insurance.

$50,000

$100,000

$150,000

Please state the amount of excess you require.(Required)

The standard policy excess is $500; if you want to reduce your excess to Nil please select the appropriate box.

Excess

Nil Excess

Prior known circumstances.(Required)

Are you aware of any claims or circumstances that are likely to give rise to a claim for legal expenses under the policy?

Yes

No

If you have answered ‘Yes’, then please provide full details.

Claim History

Property/goods damage

In the last 5 years, have you or your family* been involved in any dispute regarding any physical damage, trespass or nuisance in relation to property that you are responsible for?(Required)

Yes

No

If you have answered ‘Yes’ to the above question, then please provide full details.

In the last 6 months, has any person including any tenant damaged any of the properties You own or are responsible for?(Required)

Yes

No

If you have answered ‘Yes’ to the above question, then please provide full details.

Repossession

In the last 5 years, have you been involved in any disputes to repossess any property?(Required)

Yes

No

If you have answered ‘Yes’ to the above question, then please provide full details.

Recovery of Rent Arrears

In the last 5 years, have You had any disputes to recover rent arrears in any property?(Required)

Yes

No

If you have answered ‘Yes’ to the above question, then please provide full details.

In the last 6 months, has a tenant of any of Your Properties defaulted in the payment of rent by the due date specified in the tenancy agreement for the property?(Required)

Yes

No

If you have answered ‘Yes’ to the above question, then please provide full details.

Tax Protection

In the last 5 years, have You been involved in any investigation or audit of your personal tax affairs by the ATO?(Required)

Yes

No

If you have answered ‘Yes’ to the above question, then please provide full details.

Prosecution Defence

In the last 5 years, have you been involved in any prosecution against You that arises from You letting out any Property.(Required)

Yes

No

If you have answered ‘Yes’ to the above question, then please provide full details.

Contracts

In the last 5 years, have You been involved in any contractual dispute where the disputed amount was more than $3,000 including GST?(Required)

Yes

No

If you have answered ‘Yes’ to the above question, then please provide full details.

Are any of Your properties available used as or available for Short-Term Holiday Letting or accommodation for periods less than 90 days?(Required)

Yes

No

If you have answered ‘Yes’ to the above question, then please provide full details.

Declaration

I hereby declare that I am authorised to complete and submit this application form. I confirm that I have read and understood the important Information set out at the front of application including but not limited to the Duty of Disclosure and Privacy Statement. I also confirm that the answers and statements provided in this application form (together with any other information supplied to insurer) are true and correct to the best of my knowledge and belief at the time of completing this application form and no material facts have been misstated or withheld. I undertake to inform the insurer of any material addition or alteration to the risk both before this policy is effected and for the period of insurance. I also agree to ARAG appointing a panel lawyer or other professional advisor on my behalf.

Signature(Required)

Name(Required)

Place(Required)

Date(Required)

DD slash MM slash YYYY

Phone

This field is for validation purposes and should be left unchanged.

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Qselect Agencies Pty Ltd, ABN 66 605 334 996 (CAR No. (1295700) A corporate representative of Oracle Group (Australia) Pty Ltd
AFSL: 363610

Phone: 1300 667 507
Email: info@qselectagencies.com.au

PO Box 824,
Spring Hill QLD 4000

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