Get a House Insurance Quote

If you'd like to receive a quote for a house insurance policy, please fill in the form below.

This will give us all the information we need to provide a quote. You will also have the option to add your contents quote to this application.

Before you begin, please refer to our House Insurance Application Guide to determine which category your house falls into for the various criteria that you will be asked about in this form.

If we require further information from you, we will contact you as soon as possible. You can already get an estimate of your premium using our Quick Estimate calculator.

If you would like to also arrange the direct debit for this House Insurance quote, please complete the direct debit authority here.

If you want to learn a bit more about what types of cover we can provide, click on this link.

Title

Miss
Master
Ms
Mrs
Mr
Doctor

Full name

Phone number

What's the best time of day to contact you?

Morning (9am - 12pm)
Afternoon (12pm - 5pm)

Email address

Have you completed an estimate for this house using our online estimator tool?

If you happen to know your Estimate ID, please enter it here:

I am already a MAS Member

Member number

Date of Birth

What is your occupation?

Postal address

Street

City

Postcode

Who will own the property:

Individual
Joint
Company
Trust

Relationship to Joint Applicant

e.g. spouse, partner, parent, friend

Title of Joint Applicant

Miss
Master
Ms
Mrs
Mr
Doctor

Full name of Joint Applicant

Date of Birth of Joint Applicant

Occupation of Joint Applicant

Contact number of Joint Applicant

Contact email address of Joint Applicant

Company name

Trust name

Name(s), in full, of trustees

Are you the current owner of the property?

Since you are not the current owner of the property, please tell us if you...

had an offer accepted to purchase this property?
are wanting confirmation of insurance before placing an offer?

When do you need this confirmation by?

Providing this date helps us ensure that we advise if we're able to offer cover within your required timeframe. If you require confirmation in the next 3 business days, please call us on 0800 800 627.

Will any business activity be run from this address?

If Yes - please describe the business activity and scale of operation.

Start insurance on:

If you require insurance to start in the next 3 business days, please call us on 0800 800 627. Otherwise, we will be in touch within 30 days of settlement.

Street address of property

City of property

Is your property classified as TC3?

This relates to properties in Christchurch City, Selwyn District, or the Waimakariri District, and may affect the type of cover we may be able to offer. You can search your property's technical category at propertysearch.canterburymaps.govt.nz

Is your house watertight, structurally sound, well maintained, secure and without any unrepaired damage?

If No - upload a Builder's Report (preferably less than 12 month's old)

Maximum 5 files (JPG, PNG or PDF); up to 20 MB per file.

Is the house classified by Heritage New Zealand (Previously Historic Places Trust) as a Category 1 or 2?

If Yes - please provide a recent reinstatement valuation if you have one.

Maximum 5 files (JPG, PNG or PDF); up to 20 MB per file.

What year was the property built?

Is the house architecturally designed?

If your house was built prior to 1935, has the house ever been re-roofed, re-piled and re-wired? If any of the previously mentioned building components are original, please describe their current condition.

Property characteristics

Please refer to our House Insurance Application Guide to answer these questions.

Select the slope for the land under the house

Flat/gentle (less than 10 degrees)
Moderate (10-20 degrees)
Steep (20 degrees or more)

Number of levels

How would you describe your home's standard of construction?

Standard
Quality
Prestige

Please describe the walls of your home a bit more in detail:

What type of roof does your home predominantly have?

Slate
Timber shingles
Metal covering
Terracotta tiles
Fibre cement covering
Membrane covering
Concrete tiles
Other

Please describe your roof a bit more in detail:

Is the roof

Flat
Pitched

What is the total floor area of the house (square metres)?

Include everything that is attached. Do not include decks, balconies, detached garages, detached carports, detached sleepouts, sheds or pergolas

Does your house have any attached garages and/or carports?

No
Yes - single
Yes - double
Yes - triple
Yes - larger than triple

Does your home have any detached garages and/or carports?

Please describe all detached garages and/or carports and include width and length for each:

How many bathrooms or en suites are in your home?

How many separate toilets are in your home?

Toilets not already counted in bathrooms and ensuites.

How many kitchens are in your home?

Are there any self-contained units on the property?

A self-contained unit has a bathroom, kitchen and sleeping facilities which can be used as a separate dwelling to the main house.

If the property has more than one self-contained unit to be insured, please describe them below.

Make sure to add unit description, number of units and floor area per unit.

Does your home have any sleepouts?

Please describe all sleepouts (include their size):

Let us know whether the sleepout is attached or detached and whether it comes with or without facilities.

Does your home have balconies?

Please describe the balconies (include size of each):

Does your home have any decks?

Please describe your decks (include size in square metres):

Does your home have any form of heating?

What type of heating does your home have?

Central heating: ducted warm air - electric
Central heating: ducted warm air - gas
Central heating: warm water - electric
Central heating: warm water - gas
Central heating: warm water - wood
Heat pump
Fireplace
Standalone gas heater
Underfloor heating

How many heat pumps does your home have?

How many fireplaces does your home have?

How many standalone gas heaters does your home have?

Does your home have any garden sheds?

Please describe your garden sheds (including size for each):

Please tell us how big your pergola is.

How many tanks? Are they small or large?

Please tell us a bit more about your Built-in pool and/or spa.

We need to know their sizes as well as whether they are made of concrete or fibreglass.

Can you give us a few more details about your tennis court?

Please let us know if lighting is present and which type of tennis court it is (Bitumen, concrete, synthetic grass, etc.)

Would you describe the extent of fencing on your property as...

Minimal: approximately 500m2 or less; Average: approximately 500m2 - 750m2; Extensive: approximately 750m2 - 1,000m2

None
Minimal
Average
Extensive

Would you describe the approximate extent of paving on your property as...

Minimal: less than 25m2; Average: 25m2 - 50m2; Extensive: 50m2 - 100m2

None
Minimal
Average
Extensive

Please tell us how long and wide your driveway is.

Would you describe the extent of retaining walls on your property as...

Minimal: approximately 10m2; Average: approximately 20m2; Extensive: approximately 40m2

Non-existent
Minimal
Average
Extensive

Describe the walls construction and condition

Are there any unusual features in your home?

E.g. sauna, solar hot water, solar electricity, home automation, etc.

What is the nature of occupancy?

Permanent residence
Holiday home
Lifestyle property
Residential rental

Is your home sometimes rented out short-term? If yes, how often is it rented out and how often do you use it as your holiday home? Cover for rented out holiday homes is limited and may attract terms.

Is there road access to the property?

How many small stock do you have on the property?

Small stock are sheep, alpacas and llamas.

How many large stock do you have on the property?

Large stock are cattle, horses and deer.

Do you earn your main income away from the lifestyle property?

What is the gross income earned from activities associated with the lifestyle block?

Please include information about any lifestyle buildings to be included in the policy.

Please include for each item a description, size, and estimated cost to rebuild.

Who manages your rental property?

Please tell us whether the property is self-managed or managed by a property management agency. If you are using an agency, please give us more details.

Is the property currently occupied?

If no, please tell us when the next tenancy is due to commence.

How many unrelated tenants reside at the property?

What sort of tenants reside at the property?

Family
Couple
Flatmates

How often do you/the property manager inspect the property?

Weekly
Monthly
Quarterly
Half-yearly
Yearly

Is smoking permitted under the terms of the lease agreement?

Are there smoke detectors fitted in the property?

There is $15,000 of automatic Loss of Rent cover. If you would like to increase this amount, please specify below.

There is $20,000 of automatic cover for Landlord's Property cover. If you would like to increase this amount, please specify below.

Landlord's Property is any appliance (including garden appliances), item of furniture, drapery or blind that you own and remains in your property within the residential boundaries of the property's address for the tenant's use, while the house is rented.

Estimated cost to rebuild/Sum insured (if known)

Does your home share an external wall, foundations, or roofline with a neighbouring property?

If Yes, please describe in detail any shared building components.

Has your house or land ever suffered from or is at risk of a natural hazard, such as flooding or land instability?

This may include a notice recorded on a property's title, such as a Section 36 or 72, which could affect natural hazard cover under your insurance. These details may also be noted in a property's LIM (Land Information Memorandum) report.

If yes, please provide details about the hazard(s), any past events, and the actions taken to manage them.

Are you aware of any Dux Qest present in your home?:

Dux Qest is a black plastic pipe plumbing system that was used in New Zealand in the late 1970s to early 1980s.

Do you have a burglar alarm?

Yes - monitored
Yes - unmonitored
No

Please provide the name of the monitoring company.

Is a sprinkler system installed?

Is there an interested party?

(e.g. if you have a mortgage your bank would be an interested party in your property)

Interested party

Voluntary Excess

When you make a claim on your House Insurance, you'll need to pay an excess. The standard excess for House insurance, irrespective of occupancy, is $500.

An additional excess may also apply in certain situations. Please read your policy documents for more information.

If you’ve also chosen a voluntary excess, you'll pay both the compulsory and voluntary excess amounts when you make a claim. The insurance will cover the rest. Choosing a voluntary excess might lower your annual premium.

Do you want to add a voluntary excess?

Voluntary excesses apply in addition to the standard policy excess.

No
Yes, $200
Yes, $500
Yes, $1,000
Yes, $2,000

Contents insurance

Do you need contents insurance?

Sum insured required:

Please let us know how much you'd like to insure your contents for.

Voluntary Excess

When you make a claim on your Contents Insurance, you'll need to pay an excess. The standard excess is $500.

An additional excess may also apply in certain situations. Please read your policy documents for more information.

Do you wish to add a voluntary excess?

Voluntary excesses apply in addition to the standard policy excess.

No
Yes, $200
Yes, $500
Yes, $1,000
Yes, $2,000

Please list any specified items to be included in your policy.

E.g. jewellery over $8,000 per item or $40,000 in total, sporting equipment over $5,000 per item, bicycles over $8,000, works of art over $25,000 each. Please provide an item description and the sum it should be insured for.

Is your house part of a Body Corporate?

If Yes - please advise how many dwellings and property owners are part of the Body Corporate.

Previous insurance and criminal convictions

The information sought by this question is subject to the rights set out in the Criminal Records (Clean Slate) Act 2004.

In the last 3 years have you, or anyone covered by this insurance, made any house or contents claims?

If yes, please provide details including year and claim description.

In the last 7 years, have you or anyone covered by this insurance had any criminal charges or convictions?

If you answered yes, please provide details of each conviction, including conviction date and sentence.

In the last 7 years, have you or anyone covered by this insurance, had any insurance refused, cancelled, special terms imposed, renewal not offered, or a claim declined?

If yes, please provide details on what happened, when and why.

If this application is to replace an existing MAS policy, please provide the policy number.

If you accept your quote, how would you like to pay the premium for your policy?

Direct Debit
Internet banking (annual lump sum)
Credit card (annual lump sum)

If you would like to pay by Direct Debit, we will send you a direct debit set up form. Or you can phone us on 0800 800 627.

Please select your Direct Debit payment frequency:

You can pay your premiums annually, six-monthly, quarterly or monthly. Six-monthly payments include a 3% payment administration fee and quarterly or monthly payments include a 6% fee.

Annually
Six-monthly
Quarterly
Monthly

Please note, Internet banking is only available when paying in an annual lump sum.

Please note, payment by credit card is only available when paying in an annual lump sum. To receive your quote, please complete and submit this form. After reviewing your quote, please phone us on 0800 800 627 to set up payment by credit card. Please note a 1.75% surcharge applies to credit card payments.

Disclosure of relevant information

I understand that I have a duty to disclose all information that Medical Insurance Society Limited (MAS) may want to take into account in deciding whether or not to accept my application and if so, what terms. I confirm that:

all answers in this questionnaire are true and correct and complete.
I have disclosed everything I know that may be relevant to this insurance.

I understand that if I have not disclosed all relevant information that I know, MAS may decline a claim I make under this policy, cancel the policy or treat the insurance as being invalid from the beginning.

Medical Insurance Society Limited has a Financial Strength Rating of A from approved rating agency S&P Global Ratings Australia Pty Ltd and this reflects our ability to pay claims.

Privacy Act 2020

I understand that:

the personal information MAS collects from me will be used to underwrite and administer my insurance.
I am entitled to access and correct the personal information MAS holds about me, in accordance with the provisions of the Privacy Act 2020.

I authorise MAS to give or obtain personal information about me (relevant to my insurance) to or from others including but not limited to the Insurance Claims Register Limited.

Please tick this box to confirm you've read and understood the declaration above

How did you hear about MAS?

Google (or any other search engine)
Family/Existing Member referral
Social Media
Radio
Print
Word of mouth
Join the Conversation (our student newsletter)
Other

You selected 'Family/Existing Member referral', please enter the full name of your referrer here.

You selected 'Other', please let us know how you heard about us.

If applying for multiple MAS quotes, please advise what other quotes you are applying for so we can process your quotes simultaneously.

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