Amend Address ROA – Amend Address Step 1 of 2 50% Name* First Last Contact Information*Contact NumberEmail AddressID NumberNew Full Physical Address* Street Address Address Line 2 City ZIP / Postal Code Do you require cover for the actual Building?* Yes No Value of BuildingDo you require cover for your Home Contents?* Yes No Value of ContentsDo you have any Thatch?* Yes No Either Roof or LapaHow Many Geysers do you have – Select Applicable 1 – One 2 – Two My Geyser is Solar Security Questions – Select Applicable* Burglar Bars & Security Gates Alarm Linked Electric Fence Living in a Secure Complex None of the Above Anything you would like us to be aware of or bring to our attention?Confirmation* The above information is true and correctBy selecting this box you confirm that all the information given on this form is true and correct. Advice, quotes and premiums are based on this information and is a record of the process undertaken by OneNet, a registered financial service provider FSP5471. If there is anything that you disagree with or do not understand please request further information.Signature
