Real Landlord Insurance

On Line Application Form

Is your property managed by an Approved Property Management Company? Yes No
If no, STOP we are unable to assist as we only cover professionally managed properties.

Is this a holiday home? Yes No
If yes, STOP we are unable to assist as we only insure permanent tenancies.

Please arrange cover on the following property/(s) with effect from / / (dd-mm-yyyy)
NOTE: Insurance cover CANNOT be back-dated

If rent is in arrears now, or has been in the previous two months, contact REAL Landlord Insurance NZ Ltd before placing cover, as restrictions may apply.

Insured name (Landlord)*: Mr Mrs Ms Miss Dr

Landlord Postal Address:
Postcode:

Phone
Home:
Mobile:
Email: *

My Property Management Company is:
Phone:

Property Manager:

Please cover the following rental property(s):
1.
2.
3.
4.

Please answer the following questions concerning your insurance history:

1.	Has any insurer ever declined to insure you or declined to renew your policy or asked that you agree to special terms or conditions?	Yes No

2.	Have you during the past three years had three or more claims under a Landlord’s Protection Policy or made a claim of more than $2,000?	Yes No

3	Have you or has any family member who lives with you:
	a: ever been imprisoned for any criminal offence, or	Yes No
	b: had any conviction for a criminal offence within the last 7 years, or	Yes No
	c: any prosecution pending for any criminal offence?	Yes No

	If you answered yes to any of the above please provide details:

	MANAGEMENT FEE: Your agent may be paid a management fee by the Insurance brokers for arranging this insurance on your behalf. This policy is underwritten by NZI, a business division of IAG. New Zealand Limited.

	I have authority on behalf of the owner of the above property(s) to request cover for the Landlord Preferred Policy. Date: / / (dd-mm-yyyy)

	YES, I have read the general terms and conditions and understand that this is an application to request cover and does not constitute approval by the insurer.