Student Contents
Accommodation Quote Request Form
AMA Chubb Masterpiece Insurance
AMA Travel
Certificate of Currency Request Form
Landlord Insurance Application Form
Motor Wheelchair Accessible Vehicles
OCV Members Professional Indemnity Insurance
Owners Corporation Quotation Request
Quotation Request Form
Student Contents
 

Student Contents

Please complete the application form below and a broker will contact you shortly.

Complete All Fields
  • Tenant Name
  • Postal Address
  • Home Phone Number
  • Mobile Number
  • Email
  • University Currently Attending
  • Cover to Commence
  • Has any insurer refused or cancelled cover or required special terms to insure you?
    Yes
    No
  • Have any of the applicants suffered any losses or had any claims made against them within the last 5 years, whether claimed for or not?
    Yes
    No
  • Have any of the applicants or any person who will receive insurance cover under the proposed policy, been charged with, or convicted of any criminal offences during the last 10 years?
    Yes
    No
  • Is the room fitted with deadlocks?
    Yes
    No
  • Are windows fitted with key locks?
    Yes
    No
  • Has or will the property be unoccupied for more than 90 days?
    Yes
    No
  • I declare that I have read Whitbread's Financial Services Guide, the Insurer's Product Disclosure Statement and complied with my Duty of Disclosure as per the Insurance Contracts Act 1984.
    Yes
    No
  • Security Code