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Home and Content Application Form

Insurance Network deals with Insurance companies like NZI, VERO, CHUBB, QBE, ANDO and others. We have a number of optional covers available for your unique situation, allowing us to tailor the insurance coverage to your needs. This means that you are not paying a premium for cover that you do not need.
Has the property had any previous damage caused by, or has the council identified it as being at risk from any natural hazard, such as flooding, inundation, landslip, erosion or subsidence? Council information would be found in the ‘Land Features’ section of a LIM report or similar document.
Is the house well maintained, structurally sound, watertight and secure?
Is the house listed on the heritage NZ register?
Is the house part of a body corporate?
Who lives in the house?
Is the house alarmed?
Is the house used for business use?
Alternative Power, Bores, Pumps, Bridges, Spa, Culverts, Cable Car, Jetties/Wharfs, Retaining Walls over $100,000 etc
Glass Breakage (no excess)
Landscaping ($50,000)
any single item you would like to note on the policy over $2,000 e.g. wedding ring, bike, camera etc
any single item you would like to note on the policy over $2,000 e.g. wedding ring, bike, camera etc
Excess Preference
Any claims/losses/damages in the last 5 years
In the last 5 years has any person to be covered under this policy, had any insurance refused, cancelled, special terms imposed, renewal or cover not offered or a claim declined?
In the last 5 years has any person to be covered under this policy has any criminal convictions not subject to the Criminal Records (Clean Slate) Act 2004?
I/We declare that to the best of my/our knowledge and belief these particulars are complete and correct. If anything changes I will inform you. If you provide information about someone else, you confirm you have their premission and that information can be used in the same way as yours.
By entering you into this insurance contract with us, you consent to your personal information being collected by us and shared by us with insurers and claims supply partners to enter into this policy with you and any claim in connection with this policy. You also consent to any personal information we hold and provide to insurers connected with any claim that you make being transferred to the Insurance claims Register, a register operated by Insurance Claims Register Ltd for use by participant insurers. The participant may access this information to manage claims.
Thank you!
We have received your submission. For any urgent assistance please call 0800868467.
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