Home Insurance Quotation Request

You can obtain a quote for your home insurance here. Simply complete the form & we will email you a quote.

Conditions of Online Quote.

Roderick Insurance Brokers Pty Ltd are a licensed insurance brokerage, who deal with many different insurance company's. We receive commission from the insurance company and we also charge a broker fee per policy. If you wish us to provide you with a quotation you must provide us with your Name and Email Address and provide honest answers to all the questions we ask.

Before making any decision regarding this insurance you should read our FSG and the Insurance Company's Product Disclosure Statement & Policy Booklet. These documents will be attached with your quote.

Acceptance of this form by Roderick Insurance Brokers Pty Ltd does not constitute acceptance of cover by us or the insurance company. It is for quotation purposes only. Should you require cover immediately you should call our office on (03) 5226 5999.

Are you happy for us to provide you with a quotation? Yes No

Contact Details
Full Name
Postal Address	Postcode
Phone
Email Address
* How did you hear about us?	I am a client I used to be a client Online Search Recommended to you Yellow Pages TrueLocal Other Client Code / Roderick reference Policy Number if known Other
Do you require your contents to be covered Australia wide for Accidental Loss &/or Damage?	Yes No
Location of Risk
Address
Suburb
State
Postcode
Building & Construction
Building Type	Other
Walls	Other
Occupancy
Year House Built
Year last rewired
Sums Insured
Building Sum Insured This amount should reflect the amount it would cost to rebuild your home	$ Check your Building Sum Insured here
Contents Sum Insured This amount should reflect the amount it would cost to replace ALL your contents	$ Check your Contents Sum Insured here
Does this sum insured include any contents items valued over $20,000?	Yes No If Yes provide details
Personal Property/Valuable Items These items may need to be specified on your policy to be fully covered.
Jewellery
Item	$
Item	$
Camera	$
Video Camera	$
Laptop	$
Bicycles	$
Surfboards	$
Mobile Phone	$
Sporting Equipment	$
Furs	$
Items containing gold or silver	$
Other
Item	$
Total	$
Security (please select all that apply to the property)
Double keyed deadlocks on all external doors	Securitel / Landline
Key Window Locks on all windows	Security Intercom
Window grills/bars on all windows	Back to Base alarm
24 hr security person/concierge	Local alarm
Security card/security pad access to floor	Fixed Safe
Unit at least 2 floors above ground

Insurance History
Previous insurance declined or cancelled ?	Yes No If Yes provide details
Ever had a renewal declined or refused?	Yes No If Yes provide details
Excess or special conditions imposed?	Yes No If Yes provide details
Had any claims/uninsured losses in the last 5 years?	Yes No If Yes provide details Please provide approx date of loss and approx $ value for each claim
Any prior claims rejected?	Yes No If Yes provide details
Been charged/convicted of a criminal offence in the last 10 years?	Yes No If Yes provide details

Other Details
Is the Insured retired?	Yes No
Insured Date of Birth	/ /
What is the size of the property? (ie acreage or town block)	Town Block Acreage (if acreage then size of block)
Do you have any non-domestic animals on the property?	Yes No If Yes provide details
Are the any business activities carried out at the property?	Yes No If Yes provide details
Do you share the building with anyone who is not a member of your family? If yes, please provide the number of non family members sharing the home?	Yes No If Yes provide details
Do you require cover for Flood?	Yes No If yes - has your home ever been flooded ?

Request a quote
Pay your account
Contact Us
03 5226 5999 Geelong
03 9974 9000 Werribee
Latest News

Home Insurance Quotation Request

Conditions of Online Quote.

Contact Details

Location of Risk

Building & Construction

Sums Insured

Security (please select all that apply to the property)

Insurance History

Other Details

Security
(please select all that apply to the property)