BCiB
Domina Insurance Brokers

Club Landlords Insurance Quote

Use this form to request a quote for insurance for a property which you rent out to tenants.

Please fill in all of the details in the fields below. If at any time you are not sure of any of the details you are required to fill in please don't hesitate to contact us for further information.

Fields marked with a * are required

Your Details

Name *
Address *
City/Town *
State *
Postcode *
Date of Birth *
Choose Date

Your Contact Details

Phone *
Mobile
Fax
Email *
Preferred contact method

Your Home Premises

Type
Are the premises used for trade or business
If yes, please give details
Construction of Exterior Walls
Construction of Roof
Construction of Floor
Age of building (estimate if unsure)
Deadlocks (doors)
Window locks
Burglar Alarm

Your Requirements

Buildings $
Landlords Contents including Fixtures and Fittings $
Loss of Rent (weekly rental amount) $
Have you made any claims on a home insurance policy in the last 5 years
If Yes, details
Additional Information
Please enter the text you see in the box below
Have you read Domina's privacy policy?
 Yes No  
Have you read Domina's Financial Services Guide?
 Yes No