Commercial Strata Insurance

Client Code:*

Name of person completing questionnaire:*

Insured Name:*

1) Are there any changes in the occupancy of the property?*

Yes
No

*If YES, please complete following.

Owner Occupied
Standard Rental
Holiday Home
Holiday Rentals

2) Have there been any material changes to fire and theft protection alarms, devices and the like during the past 12 months?*

Yes
No

* If YES, please advise full details.

3) Have there been any material changes to common property (i.e. lifts, escalators, pools, gyms, etc) and the like during the past 12 months?*

Yes
No

* If YES, please advise full details.

4) Is there any history of flood damage at the insured location(s)?*

Yes
No

* If YES, please advise full details.

Loss of Rent / Temporary Accommodation Expenses

This section of the Policy is designed to protect loss of rent and/or meet temporary accommodation expenses in the event of damage to the premises. You will need to advise us of the estimated rental income for next 12 months plus an allowance for any increase which would have applied during the period of repairs and/or or re-building.

5) Estimated Rental Income $ (incude %)*

Machinery Breakdown

6) The level of cover and sums insured must be reviewed to ensure they are adequate and continue to meet your requirements. Please advise any changes that are required.*

7) Have you installed new machinery / equipment in the last policy period?*

Yes
No

* If YES, please advise full details.

Legal Liability and Office Bearers Liability

8) Number of Office Bearers*

9) Do you engage a Professional Body Corporate Management Service?*

Yes
No

If YES, who?

Fidelity Guarantee

10) Do you require cover for theft or embezzlement of money and cash?*

Yes
No

If YES, what limit is required ($)

Voluntary Workers Compensation

11) Do you engage the services of any voluntary workers?*

Yes
No

*If YES, What is the type of work performed:

How many workers are engaged ?*

What is the estimated annual payments to workers ($)*

Claims Declaration

12) Details of any claims that have occurred, but have not yet been reported.*

13) After specific inquiry, details of any facts, circumstances or incidents (other than those already disclosed, notified to your insurer) which could give rise to claims against yourselves in the future.*

All changes or inclusions of any sort or type, including limits or sums insured shown, will take effect from the policy's expiry date unless you request otherwise.

Information we have provided to Sarina Insurance Brokers, is to the best of our knowledge correct. Please type your name below:*

Phone

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Loss of Rent / Temporary Accommodation Expenses

Machinery Breakdown

Legal Liability and Office Bearers Liability

Fidelity Guarantee

Voluntary Workers Compensation

Claims Declaration

Sarina Insurance

General Info

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