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Online Application Form

Please fill in the form below to apply for instant cover.


Applicants Details

Full Name:


Email Address:


Postal Address


Contact Phone Number:


Addtional Phone Number (optional):


Date insurance is to start:

 
Properties to insure:



Properties to be Insured

Address of Property:



Property Questions

Are the properties in a sound condition?
Yes
 No
Do you have current insurance for your properties?
Yes
 No
Are the tenants' bonds registered with Tenancy Services?
Yes
 No

If you have answered 'No' to any of these please give full details.



General Questions
Each question must be answered on behalf of You ( the person applying for this insurance) and also any other person who may be covered under the insurance which is being applied for.

Have you claim on any type of insurance in the past 5 years?
Yes
 No
Has any Insurance Company ever refused to insure you?
Yes
 No
Has any Insurance Company ever cancelled, refused to renew or imposed special conditions on insurance held by you?
Yes
 No
Have you ever been found guilty of a criminal offence or is any prosecution pending? (excluding parking or speeding offences)
Yes
 No
Has there been any damage by tenants (whether insured or not) in the past 5 years? 
Yes
 No
Have you had any problems with your current tenants?
Yes
 No
Is there any other information likely to affect the acceptance of this application?
Yes
 No

If you have answered 'Yes to any of these please give full details.


I accept the Terms and Conditions

Rentsure
Specialists Landlord Insurance

T 64 09 274 1692

F 64 09 274 1695
P PO Box 64006 Botany, Auckland