Unoccupied Property Form - Australia Underwriting

The Insured (Must be registered to a commercial entity for Residential properties)

ABN

Names of the directors) or trustee(s) of the insured entity

Interested Party(s)

Period of Insurance

Period of Cover

Your current, proposed or expiring premium

Type of Premises

Risk Address

Important Information to be declared:-

We rely upon this proposal form and it is important to us that you make specific enquiries with each applicable party described in (i), (i), (i) & (iv) below prior to answering the questions and signing the declaration.
If you feel unable to answer a question(s) accurately or have a material fact or circumstance(s) to disclose please provide full details in the additional information box on page 5.
(i) You and insured family members
(ii) Any Director or Partner
(ili) Any person (s) with a beneficial interest of 25% or more in the business (other than mortgagees)
(iv) Any person with management control of the insured entity (other than professional letting agents that you have contracted to manage the property:

Have any of the parties described in (i) - (iv) above:

1. Been convicted of, or had any fines or penalties imposed for, a criminal offence in the last 10 vears?

Yes No

2. Been placed in bankruptcy, receivership or liquidation within the last ten years?

Yes No

3. Had any insurance refused, cancelled or had special conditions or restrictions imposed on your policies?

Yes No

4. Has another insurer made risk recommendations in respect of your business that have not been attended to?

Yes No

5. Are there any exceptional circumstances or anything special or unusual about your business which would increase the likelihood of loss, destruction, damage or liability?

Yes No

6. Made a claim or suffered a loss by any event for which Insurance is now being proposed within the last five years?

Yes No

If you have answered Yes to any question(s) or feel that you have been unable to answer a question(s) accurately, please provide full details

The Property

8. Are any parts of the premises occupied either by you or any tenants?

Yes No

If yes, please provide more details?

Approximate age of the building:
(either the age, year of build or decade the building was built)

9. Approximate square meters of the building:

10. Number of storeys of the building:

11. Number of storeys of the building:

12. Number of buildings on the property:

13. Is the property heritage listed?

Yes No

14. How long have the Premises been unoccupied?

Less than 12 months

Up to 2 Years

3 - 5 Years

5 Years +

15. How long is it anticipated that the Premises will remain unoccupied?

What is the future for the building?

Construction: a) Walls

B) roof

c) Floor

d) Contains EPS (Coldroom, Expanded Polystyrene or Insulated Sandwich Panels)
If yes, please confirm which of the following represents EPS:

A cool room that is separate to main structure

Yes No

A cool room that is part of the main structure that is less than 20% of the total building footprint

Yes No

A cool room that is part of the main structure that is greater than 20% of the total building footprint

Yes No

EPS (not a cool room) less than 20% of the building

Yes No

EPS (not a cool room) more than 20% of the building

Yes No

If yes, please provide more details?

Approximate age of the building:

Approximate square meters of the building:

Number of storeys of the building:

Number of buildings on the property:

Is the property heritage listed?

How long have the Premises been unoccupied?

Less than 12 months Up to 2 Years 3 - 5 Years 5 Years +

How long is it anticipated that the Premises will remain unoccupied?

What is the future for the building?

Construction:

Floor

Steel Wood Concrete Other

d) Contains EPS (Coldroom, Expanded Polystyrene or Insulated Sandwich Panels). If yes, please confirm which of the following represents EPS:

A cool room that is separate to main structure. A cool room that is part of the main structure that is less than 20% of the total building footprint. A cool room that is part of the main structure that is greater than 20% of the total building footprint. EPS (not a cool room) less than 20% of the building. EPS (not a cool room) more than 20% of the building

If yes, please provide more details?

Is answered YES to Asbestos within the property? Please provide details below, including % of building area.

If answered other in the other, please provide additional details below.

In a good state of repair and will be maintained?

Yes No

If not, please provide further details

Constructed with a flat roof (other than concrete)?

Yes No

If yes, please provide more details incuding building material installed and % ? (If insufficient space provide details in Additional Information section on page 5)

Are the adjacent premises occupied?

Yes No

If yes, what are they occupied as? (If insufficient space provide details in Additional Information section on page 5)

Is the property above the 26th parallel?

Yes No

Sums to be Insured

Section 1 - Physical Damage

Buildings (including outbuildings) representing full cost of reconstruction in their present form)

Removal of Debris

Landlords Fixtures, Fittings and Fitted Furniture

Contents

Glass: Please state limit required

Section 2 - Claims Preperation Costs

Claims Preperation

Section 3 - Property Owners Liability

AUD 10,000,000 Limit

Yes Np

Property Protections

UNOCCUPIED PROPERTY PROPOSAL FORM

Insured Information

The Property