Application for Home˜Insurance

1 Application for home InsuranceCompleting this formBefore you begin your Application , please read the Statement of Conditions. If you don t already have this document, or if you have any questions about it, please ring 1300 552 you need more space to answer questions, or if you need to tell us additional information, please use the space on page 9 or provide an attachment with the required for DSH InsuranceDSH Building insurance is only available to eligible answers to questions 4, 5, 6, 7 and 8 will help us assess if you are eligible to use the insurance : Eligibility to insure with the Defence Ser vice Homes insurance Scheme does not guarantee entitlement to assistance under the Defence home Ownership Assistance of disclosureWhat you must tell us: When answering the questions on this form, you must be honest and you have a duty under law to tell us anything known to you, and which a reasonable person in the circumstances would include in answer to the questions.

2 We will use the answers in deciding whether to insure you, and on what needs to tell us: It is important that you understand you are answering our questions in this way for yourself and anyone else you want to be covered by the you do not tell us: If you do not answer the questions in this way, we may reduce or refuse to pay a claim, or cancel the policy. If you answer the questions fraudulently, we may refuse to pay a claim and treat the policy as never having you are not sure about the duty of disclosure requirements, please ring 1300 552 APersonal details2 Details of the rst owner of the home to be nameGiven name(s)TitleMrsMissMsOtherMrHome( )Date of birthPOSTCODEWork( )Fax( )MobileBuilding Policy Number3 Details of the second owner of the home to be there are more than two owners please provide the additional details on a separate 10/16 P1 of 10E-mail1 Do you want us to insure your home or provide you with a quote for your further addressFamily nameGiven name(s)TitleMrsMissMsOtherMrHome( )Date of birthPOSTCODEWork( )MobileFax( )E-mailPostal address9 Are you currently insured or haveyou had home building insurancebefore?

3 YesNoName of current or most recent home insurerExpiry date of the current or previous insurance policy4Do you have or have you previouslyhad a Defence (or War Service) home Loan?YesNo5Do you have or have you previouslyhad a Defence home Owner(DHOS) loan on the home to beinsured?Area of eligible serviceDatestotoSECTION A continuedPERSONAL DETAILS8 Please give details of your servicewith the Australian Defence Force(or, if you are widowed, the serviceof your late partner).tototoIf insufficient space, please provide details on page 9 Owner 1 YesNoOwner 2 Type of serviceYesNoYesNoPermanent Reserve6Do you have a current SubsidyCertificate or receive a subsidyunder the Defence HomeOwnership Assistance Scheme Act(2008) (DHOAS)?YesNoYesNo7 Were/are you an ADF member inreceipt of, or are you entitled toany pension or other benefit fromDVA under the Veterans Entitlements Act 1986?YesNoYesNoHome insurance not due? We will contact you nearer the time to remind you to checkDefence Service Homes value for money premiums and 10/16 P2 of 1010 Have you, or anyone normally livingwith you, ever: been refused insurance been declined renewal ofinsurance been quoted an increasedpremium, or had any special terms orconditions imposed?

4 11 In the last 5 years, have you, oranyone normally living with you,been charged or convicted of: arson or any offence involvingactual or threatening damage toproperty any criminal act fraud theft drugs, or dishonesty of any kind?12 Have you, or anyone normally livingwith you, made a buildinginsurance claim in the last fiveyears?13 Is there any other information thatis relevant to our decision to insureyour home ?YesNoPlease provide details including type of offence, year and amountFor example, fined $500 in 2013 for shop provide details including type of claim, year and amountFor example, storm claim approximately $3,500 in provide detailsYesNoYesNoPlease provide details. For example, excess imposed by an insurancecompany in 2013 following theft A continuedPERSONAL DETAILS14 Address of home to be insured.(if same as postal address,write SAME )POSTCODED7529 10/16 P3 of 10 YesNoDo you intend to claim all or part of the GST component of your insurancepremium as an Input Tax Credit?

5 17 Will you be conducting a GSTregistered business from theinsured property?YesNoABNWhat percentage of the GSTcomponent will be claimed?%SECTION A continuedPERSONAL DETAILS15 How did you become aware of yourentitlement to DSH insurance ?Please tick all boxes that applyDSH insurance phone callInsurance mail outWord of mouthRSLV eterans and Veterans Families Counselling ServiceVeterans Advisory Network (VAN)FriendDSH information talkTransition seminarDVA mail outOther ex-service organisationPlease specifyService newspaper or journalOtherI have had DSH insurance beforeSubsidy Loan: DHOASO ther give details and if vacant, details of security arrangements and anticipated end date to thevacancyYesNoPlease provide details16 Will any business activity beconducted on the premises?SECTION BHome detailsInternet searchSubsidy Loan: DSHS ubsidy Loan: DHOS20 How is the home occupied?By you as ownerHoliday homeHome is vacant (unoccupied for more than 90 days)By a tenant or relative (living in your home )18 When is the insurance tocommence?

6 Year of constructionOn Base Advisory Service (OBAS)YesNo19 Is the home over 70 years old?NoYesNoYesYearYear replumbed?Has it been: rewired?D7529 10/16 P4 of 10 SECTION B continuedHOME DETAILSYesNoYesNoIs there Body Corporate building insurance policy covering all the units?22 Is the home strata title?FibroOther give detailsOther give details23 Construction brickBrick veneerWallsWoodTilesColorbondRoofIronFib roCeiling Does the home have working smokedetectors?YesNo25 Is the home on land larger than 2hectares (5 acres)?Please provide areaYesNo26 Is the home located within 500m inany direction of any bushland orforest?YesNo27 Is the property within 10m of theocean or a watercourse?Please provide detailsYesNo28 Has the home ever been affectedby flood?Please provide detailsWe calculate the sum insured based on the full replacement cost of your home from information you supply. The full replacement cost of yourhome is influenced by your responses provided on this Application sum insured is based on the cost of building a new replacement home and it is not determined by the market value of your home (theselling price of your home ).

7 It also includes the cost of replacing all your fixed domestic improvements, plans and permits, GST and removalof debris following a major you have any other information to help us with the calculation of the replacement cost we ask you to tell Do you wish to calculate thereplacement cost of the home ?YesNoPlease go to the next QuestionPlease go to our website and complete the Building Replacement CostCalculator, and attach a copy of the report (available after completing the ResidentialValuer) to your Application form. Please go to Question 35 BlockworkStoneworkTerracottaConcrete21 Type of give detailsFreestanding houseHome unit/FlatTownhouse/Terrace/VillaSemi detached houseDuplexOn site vanGranny flatD7529 10/16 P5 of 10 SECTION B continuedHOME DETAILS30 Do you know the size of your home ?32 Is the home built on a slopingblock?NoYesPlease provide the following measurements or attach a copy of the planPlease go to the next Question Total size of the homesq m ORsquares Lower living areasq m Upper living areasq m Garagesq m Porchsq m Patiosq m Verandahsq m31 To what standard is your homebuilt?

8 AverageStandard designLaminated kitched bench tops &cupboard doorsBasic appliances & tapwareFramed shower screensBasic aluminium windowsFlush faced doorsSteel door furnitureSimple architraves & skirtingsPlain ceilings & cornicesAverage ceramic tilingMinimal electrical facilitiesQualityArchitectural designGranite or laminated timber kitchenbench topsVinyl or polyurethane kitchen cupboarddoorsEuropean appliances & tapwareSemi framed or frameles showerscreensTimber or improved aluminium windowsFeature doorsEuropean door furnitureLarger architraves & skirtingsDecorative ceilings & cornicesPorcelain tiling (floor to ceiling)Average electrical facilitiesPrestigeComplex architectural designGranite kitchen bench topsPolyurethane or solid timber kitchencupboard doorsEuropean appliances & tapwareFrameless shower screensTimber or improved aluminium windowsCustom doorsEuropean door furnitureLarger archtraves & skirtingsDecorative ceilings & cornicesStone tiling (floor to ceiling)Extensive electrical facilitiesFlatGentle (5 degrees)Moderate (15 degrees)Severe (30 degrees)D7529 10/16 P6 of 10 SECTION B continuedHOME DETAILS33 Does the home have any of theseadditional features?

9 Fences, gatesMinimalAverageExtensiveNoneRetainin g wallsMinimalAverageExtensiveNonePavingMi nimalAverageExtensiveNoneShedSmallLargeN oneRainwater tankSmallLargeNoneSpaIngroundFibreglassN oneSwimming pool(inground or with deck)ConcreteFibreglassNoneSolar powerLess than 2 kwMore than 2 kwNoneSolar Hot Water SystemYesnoneAir conditioner/Split cycleLess than 2 kwMore than 2 kwDuctedSecurity system/alarmNoYesSecurity shuttersNoYesFloating floorNoYesDucted HeatingNoYesPergolaSmallLargeSkylightsNo YesLiftNoYesGranny FlatNoYesYesNoPlease provide details34 Does the home have any otherspecial features?For example, highset, more than onelevel, on stumps, modifications forelderly occupants. For highsethomes provide details of anyunderfloor attach your additional information to your Application or use the space providedon page 9 of this Do you have any further recent costinformation to provide to help usassess the replacement value ofyour home ?Please go to the next QuestionYesNoPlease provide details36 Is the home heritage listed?

10 No37Is the home connected to townservices ( water, gas,electricity)?YesPlease provide detailsYesNo38 Is the home Council approved?NoneD7529 10/16 P7 of 10 YesNo39 Is any part of your home underconstruction?SECTION B continuedHOME DETAILSYesNoPlease provide details40 General condition of the homeAverageGoodNeeds maintenance or repairs please provide details41 Is the home under renovationrequiring the removal of the roof?Undergoing renovations or reconstruction - please provide detailsFor example, is the home stucturallysound, secured and wellmaintained?YesNoPlease provide details of lender42 Do you have a mortgage?NameYesNo43 Do you wish to pay your premiummonthly?44 declare that: I have received a copy of the Statement of Conditions and I agree to be bound by the termsand conditions contained in it. All answers and statements made in this Application are true and accurate in every respect. No information has been withheld which is likely to affect the Defence Service HomesInsurance Scheme decision about accepting this Application .