Landlord Insurance Form

Property Insurance Plus

Request for PIP Landlord Cover
Date
MM slash DD slash YYYY
Real Estate Agent:
Property Manager:
Property Manager's Email Address:
Issue invoice to:
- Property Manager
- Landlord
LANDLORD DETAILS
Landlord's name:
- Mr
- Mrs
- Ms
- Dr
First Name Last Name
Landlord’s personal postal address:
Landlord’s contact number: (m)
Landlord’s email address:
RENTAL PROPERTY DETAILS (property to be covered)
Property Address:
Street Address
City / Suburb
State
Post Code
Date Cover to Commence (cover cannot be backdated):
MM slash DD slash YYYY
What is the weekly rent at this property($)?
BUILDING INSURANCE
If the property is a House – complete the following
Building insurance – What amount does the Landlord want the property insured for?
$