Add Contents Adviser Name (if known) First Name Last Name What would you like us to do? (our Scope of Service) * Add contents to my existing policy Create a new contents policy Change the address of my existing contents cover Policy Number * Your Name * First Name Last Name Are you to be the insured person? * YES NO What is your date of birth? MM DD YYYY Phone (###) ### #### Email Do we need to note a second person as an additional insured? YES NO Address Address 1 Address 2 City State/Province Zip/Postal Code Country What date do you want cover effective from? MM DD YYYY Address where contents are located Address 1 Address 2 City State/Province Zip/Postal Code Country Type of property where the contents are located Owner occupied home Rental property Owner occupied home and rental Holiday home Unoccupied home Storage Other Use Home Contents Sum Insured Calculator that can be found on our Resources page to help you get a general indication of some of the contents that might be found in a home. The values used are notional only and do not take into account the quantity, quality, age or model of your contents. Once you've completed this, please email us a copy: reception@kwa.nz Nominated Sum Insured - ($) Is this figure? Incl. GST Excl. GST Not sure - contact me to discuss Type of cover required Maxi Cover - Comprehensive Cover, and includes accidental cover, NZ wide cover and replacement value cover for most items (min. $40,000 sum insured) Flexi Cover - Basic Cover, but can add some extra options as desired Are any contents used for business purposes? YES NO Security of contents? None Unmonitored Alarm Monitored Alarm Please see below a list of items that need to be specified: - $5,000 for any one bicycle including any e-bike - $3,000 for any one item of camera/video camera equipment - $3,000 for any one canoe/kayak, surf ski/board, paddleboard, kite/wind-surfer - $3,000 for any drone - $5,000 for any one item of jewellery or watch - $1,000 for any one individual coin, card, or stamp - $3,000 for any collection of coins, cards, or stamps - $1,000 in total for gold/silver/bullion or precious metals (in total for any one claim for one or more items) - $1,000 in total for unset precious or semi-precious gemstones or minerals (in total for any one claim for one or more items) List any items to specify: If available, please email us a valuation for jewellery: reception@kwa.nz Standard Excess ($) 250 (most popular) 500 750 1000 2500 5000 Have you made any contents related insurance claims within the last 12 months? YES NO Moral Questions Have you or your family members, or any other person or entity to be covered by the insurance: Made more than two claims in the last two years: YES NO Been bankrupt in the last 10 years? YES NO Been aware of any damage from flooding, landslip or earthquake at any address relating to this policy? YES NO Had any insurance declined, cancelled, avoided, renewal refused, terms or conditions imposed or claim denied? YES NO Engaged in any criminal activity or had any criminal convictions, acquittals or diversions, or have any criminal prosecutions pending? YES NO Declaration & Privacy Statement By ticking this box, I confirm I have read and understood the following authorisation statements On completion of this form our advisers will send you a Scope of Service and Disclosure Statement. If you have any questions prior to completing this form, please contact us. Additional notes or queries that may affect your insurance? By ticking this box and completing and submitting this proposal form, I/we declare that to the best of my/our knowledge and belief these particulars are true, complete and correct. Subject to any right I/we have under the Clean Slate Act, I/we have not withheld any information or any other material fact likely to affect the provision of cover. Is there anything else you would like assistance with? (we will contact you) KiwiSaver Home Loans Life/Health Insurance Domestic Insurances - e.g. house, vehicle, boat, trailer, campervan Business Insurances Thank you! Book a free consultation Book consultation
