Home Warranty Insurance Claim Form

Home Warranty Insurance Claim Form General WFI Insurance Limited (ABN 24 000 036 279) trading as Lumley Insurance offers Builders Home Warranty Insurance to owner Builders and Licensed Builders in the form prescribed by the relevant State or Territory Legislation throughout Australia, namely: Victoria The Building Act 1993 including the Ministerial Order made under the Building Act 1993; New South Wales The Home Building Act 1989; Tasmania The Housing Indemnity Act 1992; Western Australia The Home Building Contracts Act 1991; Australian Capital Territory The Building Act 2004; South Australia Building Work Contractors Act, 1995; And further, any Regulation made to any of those Acts. The policies of insurance issued in respect of Builders Home Warranty Insurance are written to comply with the relevant State Legislation. The policies are designed to protect building owners (where the building owner is not the builder), purchasers and subsequent purchasers against loss suffered or incurred as a result of a defined event under the terms of the policy of insurance and/or under the provisions of the relevant State Builders Home Warranty Insurance Legislation. If we elect to pay you an agreed sum of money in settlement of a claim, you will be required to enter into a contract with an appropriately licensed/registered contractor/builder, who must provide Builders Home Warranty insurance to cover the proposed completion/rectification works Other important claims details The nature of your policy indemnifies for loss from defective work under a building contract. Your contract with your builder (or the original contract if you are not the person who contracted with the builder) is required to determine what your policy covers. Claims can t be confirmed without a full copy of the contract, its plans and specifications and with the other information in this claim form. When you must make a claim Please read the policy wording carefully before making a claim to ensure that you are within the period of cover for the items you intend to claim. A claim cannot be accepted if you have NOT notified Lumley Insurance of your loss within the period of cover as prescribed in the legislation and referred to in the policy wording. Do not authorise completion/rectification works yourself You should not negotiate or settle any claims for losses or damage; or incur any costs or expenses without first obtaining our consent in writing. If you do, your rights against us, if any, may be affected. However, any temporary/emergency repairs necessary to prevent further damage may be carried out immediately. If you have any questions about your claim, please contact us. Your duty of disclosure. You have certain disclosure obligations that you must comply with. What you must tell us When answering our questions, you must be honest and you have a duty under law to tell us anything known to you, and which a reasonable person in the circumstances, would include in answer to the questions. We will use the answers in deciding whether we are obliged to pay a claim. If you do not tell us If you do not answer our questions in this way, we may reduce or refuse to pay a claim. If you answer our questions fraudulently, we may refuse to pay a claim. In either case, if we have already made a payment in relation to your claim, we may seek recovery of that payment from you. Privacy Statement The Privacy Act (Commonwealth) 1988 as amended now applies and requires Lumley Insurance to inform you that: Collection and access of personal information The information we collect will be used for the purpose of properly administering your claim or claims brought against you. If you wish to access your information we hold about you, please contact us. In some circumstances we may not agree to allow you access to some or all of the personal information we hold such as when it is unlawful to give it to you. In such cases we will give you reason for our decision. How we use your personal information. The information we collect is used to help us provide you with your insurance product. In order to assist us in setting your claim, it may be necessary for us to disclose your personal information to other organisations or people including those who assess claims or provide medical opinions. We may also disclose your personal information to other parties as required by law or to third party service providers. They are also required to comply with privacy obligations. 1

How you can resolve a dispute with us When a claim is made, and a decision made by Lumley Insurance, you have rights of appeal. Our dispute resolution system is free and works like this: 1 Please advise Lumley Insurance claims staff if you are dissatisfied with: Our decision on your claim, Our handling of your claim, The services of our technical consultant. 2 If the staff member is unable to resolve it, the staff member will refer it to the Supervisor or Manager, for immediate attention. 3 If this fails to resolve your problem, you may request that the issue be referred to the Internal Dispute Resolution Manager. This officer will investigate the dispute and try to reach a satisfactory outcome with you, normally within 21 days of the date you requested the service. 4 Should you dispute this decision you should make application to the relevant body, authority or Tribunal. The Identity of that body shall be advised to you at the time the decision is made. Particular note should be made of the time periods within which you are able to make application for review of the insurers decision. More detailed information about this process is available by contacting us. 2

Please answer all questions using block letters. This will help us to process your application quickly. Items marked with an asterisk (*) are mandatory fields Section 1: Claimants Details (Name of all owners shown on property title) Policy / Certificate number* Issue date Surname / Company Name or Strata Plan number* Title Given name(s) Postal address Suburb/town State Postcode Home phone* Work phone* Mobile* Fax Email address Section 2: Site Address (the subject of this claim) Lot number or Street number Street name Suburb/town State Postcode Is any part of the premises used for non-residential purposes? E.g. shop, office, parking, etc. Is the premises part of a Strata Body? Are you entitled to claim a GST Input Tax Credit with regards to the matters in this claim?* Please provide ABN If YES please state your ITC % % Section 3: Builder / Owner Builder Details Please complete the following information about your builder to assist us in contacting them as part of managing your claim Builder Name (Individual name or company name)* Lot number or Street number Street name Suburb/town State Postcode After hours phone Work phone Mobile Please indicate the current trading status of your builder to assist us in determining how the policy is applied. Refer to Page 7 for definitions 1 Is the builder Insolvent? 2 Is the builder Deceased? 3 Has the builder Disappeared? 4 Is the builder still registered / trading? If yes to answers 1-4, how and when did you become aware of the fact? Please attach any documentary proof 5. Were you aware of the defects prior to the builder becoming Insolvent, Deceased or Disappeared? If so did you advise the builder? 6. If you believe the builder has disappeared, what have you done to try and locate the builder? Please attach any documentary proof 7. If the builder is still registered, what action have you taken to have the builder return? 3

8. (for NSW only) If you had a CTTT hearing, was a money order issued in your favour? If yes, What was the value of the order? $ 9. Has the builder satisfied/paid the order? Section 4. Type of Claim Defects* If yes, Complete section 5 Incomplete* If yes, complete section 6. Section 5. General Claim - Defects When were the building works completed by the builder? Refer to page 7 for definitions / / Have any complaints been previously lodged or claims made by you or a previous owner in relations to the works undertaken by the builder?* If yes, provide a brief explanation and copies of documents held. Are you aware of any other Tribunal, Court or Legal actions concerning the property? If yes, provide a brief explanation and copies of documents held. Are you related to the builder and/or developer in the building contract? If yes, provide a brief explanation Did you contract with the builder or are you a subsequent owner? Original If original, go to (A) Subsequent If subsequent, go to (B) (A) Original Owner Who arranged for the design of the dwelling? You Builder If answered You, please provide details of your design engineer or architect. Were any of the defects being claimed known to you prior to the completion of the works? If yes, did you notify the builder in writing? If yes, please provide a copy of the notice Were any of the defects being claimed part of variations to the work in the building contract? If yes, please provide details and a copy of the signed agreed variation What was the contract amount? $ Has the contract been paid in full? If no, how much is still to be paid? $ (B) Subsequent Owner When did you purchase this property? Did you obtain a Pre-Purchase Inspection? If yes, please provide a copy of the Report Were any items being claimed known to you prior to purchasing the property? If yes, what action did you take to have the vendor rectify the defects? If the vendor did not rectify, did you received a reduction in price? 4

Required Documentation General Claim - Defects In order to ensure your claim is processed as quickly as possible, please provide copies of all documents listed below when you submit your claim form. Original Owner Building Contract* Certified Plans* Specifications* Variations (agreed and signed by all Parties)* Occupation Certificate or Certificate of Completion* Subsequent Owner Building Contract (if available) Proof of ownership, such as Contract of Sale, Land & Title Search or Rates tice Approved plans Occupation Certificate or Certificate of Completion Registered Strata Plan (if claim lodged by Owners Corporation or Body Corporate) Strata Roll (if claimed by Owners Corporation or Body Corporate) If available, please provide copies of the following: Building Inspection Report Pre-purchase inspection report Correspondence issued to Builder and/or Developer Any responses from Builder and or Developer Development approval Inspections and Certification Certificates. Section 6. General claim information - Incomplete Have the building works started?* If yes, When? / / When was the builder last on site?* / / Were you responsible for engaging or arranging the design of your dwelling?* If yes, provide details of the design engineer and/or architect Were there any variations to the contract?* If yes, please provide copies of the agreed variations. What was the final contract sum including any agreed Variations?* $ To date how much have you paid the builder for works completed as per the contract?* $ What amount of monies remains to be paid under the contract?* $ According to the contract, what stage are the works up to?* Required documentation - Incomplete Building Contract Approved Plans Specification Scope of works and/or Tender Variations (agreed and signed by all parties) Receipts and/or evidence of progress payments made Inspections (either from Council and/or Private certifier) 5

Definitions COMPLETION: For the purpose of determining the period of cover we need to know the date that your home was completed. In NSW the meaning of completion date is set out in Regulation 71 of the Home Building Regulation 2004. A summary of the definition is as follows: Completion is defined as either: a) The date that the work is completed within the meaning of the building contract; or b) If a contract does not provide for when work is to be completed (or there is no contract), the completion of residential building work occurs on Practical Completion of the work, which is when the work is completed except for any omissions or defects that do not prevent the work from being reasonably capable of being used for its intended purpose. c) It is to be presumed (unless an earlier date for practical completion can be established) that practical completion of residential building work occurred on the earliest of whichever of the following dates can be established for the work, d) The date on which the contractor handed over possession of the work to the owner, e) The date on which the contractor last attended the site to carry out work (other than work to remedy any defect that does not affect practical completion), f) The date of issue of an occupation certificate under the Environmental Planning and Assessment Act 1979 that authorises commencement of the use or occupation of the work, g) (in the case of Owner-Builder Work) the date is 18 Months after the issue of the owner-builder permit for the work. In all other states the date of completion is the date in which the Occupation Certificate was issued. BUILDERS STATUS: Insolvent When a Company is being administered by an external body such as a Receiver or Liquidator and is therefore in Administration or Liquidation as per the Corporations Act 2001 of the Commonwealth. Bankrupt When an individual has a personal status of an undischarged bankrupt. Deregistered When a company ceases to exist and has had its status altered to reflect Deregistered (as found in ASIC Australian Securities and Investment Commission) Deceased When an individual has passed away. Disappeared When an individual cannot be located after due search and enquiry, which includes but not limited to: a) Making contact on all know numbers b) Attending the last known address; and c) Undertaking web-based searches. d) Lodging a complaint with the relevant building/licencing authority. Suspended When the builders licence has been suspended by the regulatory authority being the Office of Fair Trading. Example defect list Exact Location Type of Loss Date first noticed If you have a report Estimated loss Right hand side exterior rear brick wall Master Bedroom right side back wall corner. Crack in bricks from ground up to base of window running at an angle through the brick joints 26 / Sep / 10 $ Water leaking through ceiling. 3 / Dec / 10 $ 6

Section 8. Detailed list of items being claimed Refer to previous page for examples 1. Exact Location Type of Loss Date first noticed If you have a report Estimated loss 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 7

Declaration: this panel MUST be completed by the applicant(s) I/We declare that: a) I/We confirm that the details on this claim form are true and represent a fair and accurate representation of the facts surrounding the claim. b) I/We consent to Lumley Insurance and its related entities, using my/our personal information I/we have provided on this form for the purpose of processing my/our claim. I/We understand that if I/we choose not to provide the required details, Lumley Insurance may not be able to process my claim. c) I/We consent to Lumley Insurance and its related entities to disclose my/our personal information to other insurers, an insurance reference service or as required by law. I/we consent to Lumley Insurance and its related entities to disclose copies of all documentation I/we have supplied in support of this claim to the original builder/contractor or their representatives. d) I/We shall provide whatever information and assistance Lumley Insurance may reasonably require to investigate this claim. Further, I/ We authorise the insurer approval to provide copies of this notice and associated documents to the Builder and other interested parties and to copy them for any associated proceedings or actions brought in any Court or Tribunal, and indemnify the insurer for any liability arising out of this action. e) I/We agree that if I/we do not comply with our duty of disclosure or if I/we have provided false information to Lumley Insurance or answered questions fraudulently, and then I/we will repay to Lumley Insurance any moneys that have been paid or cost incurred by Lumley Insurance in relation to this claim. f) I/We assign to Lumley Insurance all of my/our rights in relation to this claim (whether against the Builder or any other party in order to enable Lumley Insurance to recover any money paid in relation to this claim and I/we authorise Lumley Insurance to commence and prosecute proceedings in my/our name to assist in recovering such money. Declared by: Print Name Signature Date / / Stamp of the Owners Corporation Common Seal FAILURE TO ACCURATELY AND FULLY COMPLETE THIS CLAIM FORM AFFECTS YOUR ELLIGIBILITY UNDER THE POLICY. Please return the completed claim form and all relevant documents to: Builders Home Warranty Claims Department Lumley Insurance PO Box 2764 Melbourne, Victoria, 3001 8