

<turbo-stream action="replace" target="form_policy"><template>
  <form id="form_policy" class="spacing-questions" data-turbo="true" data-controller="address-find reset-fields refresh-form" data-address-find-api-url-value="https://api.suncorp.com.au/address-search-service/address/find/v3" data-address-find-param-key-value="policy" data-action="address-autocomplete#choose-&gt;reset-fields#reset
change-&gt;refresh-form#refresh
address-autocomplete#choose-&gt;address-find#find
autocomplete#change-&gt;address-find#find
address-find#responded-&gt;refresh-form#refresh
" action="/policy_details" accept-charset="UTF-8" method="post"><input type="hidden" name="authenticity_token" value="ZZoPTEI1JZzZiwP2vbKqcMho7sSTRPaRsI4uO1MdOKMBJFwi3xvwfnjO7xQH78qlEMvrroOgXkN-dg1Ti7Pz9w" />

  <div class="spacing policy_cover_option">
  <div class="cover-options">
    <label for="policy_cover_option">Choose a cover option</label>
    <input type="hidden" name="policy[cover_option]" value="" />
      <input autocomplete="off" type="radio" value="1" name="policy[cover_option]" id="policy_cover_option_1" /><label tabindex="-1" for="policy_cover_option_1">Landlord Insurance <span class='hint'>Residential Tenancy or Holiday Rental</span></label>

      <input autocomplete="off" type="radio" value="2" name="policy[cover_option]" id="policy_cover_option_2" /><label tabindex="-1" for="policy_cover_option_2">Building Insurance</label>

      <input autocomplete="off" type="radio" value="3" name="policy[cover_option]" id="policy_cover_option_3" /><label tabindex="-1" for="policy_cover_option_3">Combined Coverage <span class='hint'>Landlord Insurance AND Building Insurance</span></label>
  </div>
  <p><a href="http://www.terrischeer.com.au/compare" target="_blank" rel="noopener">Compare our cover options</a></p>
</div>

  <div class="spacing-xx-tight policy_eligibility_criteria">
  <label for="policy_eligibility_criteria">Do any of the following statements apply to you or anyone to be insured under this policy?</label>
  <ul>
    <li>Your property or any part of the property is owner occupied</li>


    <li>Your property is a commercial property</li>
    <li>Your property is a building in the course of construction</li>
    <li>Your property is a boarding house, college, dormitory, mobile home, caravan or a temporary building or structure</li>
    <li>Your property is a dwelling situated in a caravan or holiday park</li>


    <li>Have had an insurer decline insurance, decline renewal on a policy or had special terms or conditions imposed
      on insurance
    </li>
    <li>Have had, in the last 5 years, 3 or more claims under a landlord or home and contents insurance policy, or made
      a claim of more than $5,000
    </li>
    <li>Have been convicted of theft or fraud in the last 5 years</li>
    <li>Are aware of any existing circumstances which may lead to a claim under this policy</li>

  </ul>

  <div class="yes-no-options">
    <input type="hidden" name="policy[eligibility_criteria]" value="" />
      <input autocomplete="off" type="radio" value="true" name="policy[eligibility_criteria]" id="policy_eligibility_criteria_true" /><label tabindex="-1" for="policy_eligibility_criteria_true">Yes</label>

      <input autocomplete="off" type="radio" value="false" name="policy[eligibility_criteria]" id="policy_eligibility_criteria_false" /><label tabindex="-1" for="policy_eligibility_criteria_false">No</label>
  </div>
</div>

  
  <div class="spacing">
  <label for="policy_property_managed">How is your property managed?</label>
  <input type="hidden" name="policy[property_managed]" value="" />
    <input autocomplete="off" type="radio" value="I manage the property myself" name="policy[property_managed]" id="policy_property_managed_i_manage_the_property_myself" /><label tabindex="-1" for="policy_property_managed_i_manage_the_property_myself">I manage the property myself</label>

    <input autocomplete="off" type="radio" value="I have a property or on-site manager" name="policy[property_managed]" id="policy_property_managed_i_have_a_property_or_on-site_manager" /><label tabindex="-1" for="policy_property_managed_i_have_a_property_or_on-site_manager">I have a property or on-site manager</label>
</div>

  
  <div class="spacing-xx-tight policy_short_term_rental">
  <label for="policy_short_term_rental">Is your property used as a short-term rental or holiday rental?</label>
  <div class="yes-no-options">
    <input type="hidden" name="policy[short_term_rental]" value="" />
      <input autocomplete="off" type="radio" value="true" name="policy[short_term_rental]" id="policy_short_term_rental_true" /><label tabindex="-1" for="policy_short_term_rental_true">Yes</label>

      <input autocomplete="off" type="radio" value="false" name="policy[short_term_rental]" id="policy_short_term_rental_false" /><label tabindex="-1" for="policy_short_term_rental_false">No</label>
  </div>
</div>

  

<div class="address-autocomplete spacing-xx-tight" data-controller="address-autocomplete" data-address-autocomplete-api-url-value="https://api.suncorp.com.au/address-search-service/address/suggestions/v1">
  <input data-address-autocomplete-target="gnafSelectedAddress" data-address-find-target="gnafSelectedAddress" type="hidden" name="policy[gnaf_selected_address]" id="policy_gnaf_selected_address" />
  <input data-address-autocomplete-target="autocompleteEnabled" data-address-find-target="autocompleteEnabled" type="hidden" value="true" name="policy[address_autocomplete_enabled]" id="policy_address_autocomplete_enabled" />

  
<span class="spacing-xx-tight" data-address-autocomplete-target="autocompleteContainer">
  <label for="policy_address_autocomplete_query">Address details for the property to be insured</label>
  <input placeholder="Start typing your address..." hint="Please make a selection from the list that appears when you start typing" label="" autocomplete="off" data-prevent-refresh="true" data-address-autocomplete-target="query" data-address-find-target="query disableWhenFinding" data-action="input-&gt;address-autocomplete#handleInput
focus-&gt;address-autocomplete#fetchSuggestions
click@window-&gt;address-autocomplete#clearSuggestions
input-&gt;address-find#clear
" type="text" value="" name="policy[address_autocomplete_query]" id="policy_address_autocomplete_query" />
  <input data-address-autocomplete-target="selection clearable" type="hidden" name="policy[address_autocomplete_selection]" id="policy_address_autocomplete_selection" />

  <ul class="suggestions-list" data-address-autocomplete-target="suggestions"></ul>
</span>


  <span class="spacing-xx-tight" data-address-autocomplete-target="manualContainer" data-hide="true">
    <div class="spacing-tight policy-holder-street-address">
      <label for="policy_Address details for the property to be insured">Address details for the property to be insured</label>
      <div class="spacing-xx-tight forms--nested">
        <label for="policy_unit">Unit</label>
        <input maxlength="10" class="small" data-address-find-target="streetUnit" data-address-autocomplete-target="streetUnit" data-prevent-refresh="true" data-action="reset-fields#reset blur-&gt;address-find#find" size="10" type="text" name="policy[unit]" id="policy_unit" />
        <label for="policy_street_number">Street number</label>
        <input maxlength="10" class="small" data-address-find-target="streetNumber" data-address-autocomplete-target="streetNumber" data-prevent-refresh="true" data-action="reset-fields#reset blur-&gt;address-find#find" size="10" type="text" name="policy[street_number]" id="policy_street_number" />
        <label for="policy_street_name">Street name</label>
        <input maxlength="50" class="medium" data-address-find-target="streetName" data-address-autocomplete-target="streetName" data-prevent-refresh="true" data-action="reset-fields#reset blur-&gt;address-find#find" size="50" type="text" name="policy[street_name]" id="policy_street_name" />
        <label for="policy_street_type">Street type</label>
        <select class="medium select-pretty" data-address-find-target="streetType" data-address-autocomplete-target="streetType" data-prevent-refresh="true" data-action="reset-fields#reset blur-&gt;address-find#find" name="policy[street_type]" id="policy_street_type"><option value="">Please select...</option>
<option value="Street">Street</option>
<option value="Avenue">Avenue</option>
<option value="Road">Road</option>
<option value="Court">Court</option>
<option value="Crescent">Crescent</option>
<option value="Lane">Lane</option>
<option value="Place">Place</option>
<option value="---">---</option>
<option value="Alley">Alley</option>
<option value="Approach">Approach</option>
<option value="Arcade">Arcade</option>
<option value="Avenue">Avenue</option>
<option value="Boardwalk">Boardwalk</option>
<option value="Boulevard">Boulevard</option>
<option value="Break">Break</option>
<option value="Bypass">Bypass</option>
<option value="Causeway">Causeway</option>
<option value="Chase">Chase</option>
<option value="Circuit">Circuit</option>
<option value="Circus">Circus</option>
<option value="Close">Close</option>
<option value="Concourse">Concourse</option>
<option value="Corner">Corner</option>
<option value="Cove">Cove</option>
<option value="Court">Court</option>
<option value="Crescent">Crescent</option>
<option value="Crest">Crest</option>
<option value="Drive">Drive</option>
<option value="Entrance">Entrance</option>
<option value="End">End</option>
<option value="Esplanade">Esplanade</option>
<option value="Firetrail">Firetrail</option>
<option value="Flat">Flat</option>
<option value="Freeway">Freeway</option>
<option value="Gardens">Gardens</option>
<option value="Glade">Glade</option>
<option value="Glen">Glen</option>
<option value="Grange">Grange</option>
<option value="Green">Green</option>
<option value="Grove">Grove</option>
<option value="Heights">Heights</option>
<option value="Highway">Highway</option>
<option value="Lane">Lane</option>
<option value="Link">Link</option>
<option value="Loop">Loop</option>
<option value="Mall">Mall</option>
<option value="Mews">Mews</option>
<option value="Parade">Parade</option>
<option value="Park">Park</option>
<option value="Parkway">Parkway</option>
<option value="Passage">Passage</option>
<option value="Path">Path</option>
<option value="Piazza">Piazza</option>
<option value="Place">Place</option>
<option value="Plaza">Plaza</option>
<option value="Promenade">Promenade</option>
<option value="Reserve">Reserve</option>
<option value="Quays">Quays</option>
<option value="Ramp">Ramp</option>
<option value="Retreat">Retreat</option>
<option value="Ridge">Ridge</option>
<option value="Rise">Rise</option>
<option value="Road">Road</option>
<option value="Row">Row</option>
<option value="Square">Square</option>
<option value="Steps">Steps</option>
<option value="Street">Street</option>
<option value="Subway">Subway</option>
<option value="Strip">Strip</option>
<option value="Tarn">Tarn</option>
<option value="Terrace">Terrace</option>
<option value="Track">Track</option>
<option value="Trunkway">Trunkway</option>
<option value="Trail">Trail</option>
<option value="View">View</option>
<option value="Vista">Vista</option>
<option value="Walk">Walk</option>
<option value="Way">Way</option>
<option value="Walkway">Walkway</option>
<option value="Yard">Yard</option>
<option value="Wharf">Wharf</option>
<option value="Other">Other</option></select>
      </div>
    </div>

    <div class="spacing-xx-tight policy_location" data-controller="autocomplete" data-autocomplete-url-value="/locations/autocompletes" role="combobox">
      <label for="policy_location">Enter the suburb or postcode of the property to be insured.</label>
      <p>Please make a selection from the list that appears when you start typing</p>
      <input data-autocomplete-target="input" data-address-find-target="suburbStatePostcode" data-address-autocomplete-target="suburbStatePostcode" data-action="reset-fields#reset" type="text" name="policy[location]" id="policy_location" />
      <input type="hidden" name="location_id" data-autocomplete-target="hidden">
      <ul class="list-group" data-autocomplete-target="results"></ul>
    </div>
</span></div>

  <span class="spacing-questions" data-reset-fields-target="container">
    <div class="spacing">
  <label for="policy_land_size">What size is your property?</label>
  <input type="hidden" name="policy[land_size]" value="" />
    <input autocomplete="off" type="radio" value="0" name="policy[land_size]" id="policy_land_size_0" /><label tabindex="-1" for="policy_land_size_0">Less than 2 acres</label>

    <input autocomplete="off" type="radio" value="1" name="policy[land_size]" id="policy_land_size_1" /><label tabindex="-1" for="policy_land_size_1">2-5 acres</label>

    <input autocomplete="off" type="radio" value="2" name="policy[land_size]" id="policy_land_size_2" /><label tabindex="-1" for="policy_land_size_2">Larger than 5 acres</label>
</div>

    <div class="spacing-xx-tight policy_effective_date">
  <label for="policy_effective_date">To give you the most accurate price, tell us the date you want your cover to start.</label>
  <p>Your policy start date must be within 30 days of today</p>
  <div class="effective-date-container">
    <span class="forms--calendar--text">6th April 2026</span>
    <div class="effective-date-picker" data-controller="effective-date">
      <label class="effective-date-button" data-action="click-&gt;effective-date#open" for="policy_effective_date">Modify Date</label>

      <input min="2026-04-06" max="2026-05-06" data-effective-date-target="date" data-reset-value="2026-04-06" value="2026-04-06" type="date" name="policy[effective_date]" id="policy_effective_date" />
    </div>
  </div>
</div>

    <div class="spacing">
  <label for="policy_dwelling_type">What type of building is it?</label>
  <input type="hidden" name="policy[dwelling_type]" value="" />
    <input autocomplete="off" type="radio" value="Freestanding House" name="policy[dwelling_type]" id="policy_dwelling_type_freestanding_house" /><label tabindex="-1" for="policy_dwelling_type_freestanding_house">House</label>

    <input autocomplete="off" type="radio" value="Townhouse Or Villa" name="policy[dwelling_type]" id="policy_dwelling_type_townhouse_or_villa" /><label tabindex="-1" for="policy_dwelling_type_townhouse_or_villa">Townhouse/Villa </label>

    <input autocomplete="off" type="radio" value="Unit/Apartment/Flat - Ground" name="policy[dwelling_type]" id="policy_dwelling_type_unitapartmentflat_-_ground" /><label tabindex="-1" for="policy_dwelling_type_unitapartmentflat_-_ground">Apartment or Flat (Ground Level)</label>

    <input autocomplete="off" type="radio" value="Unit/Apartment/Flat - 1st Floor" name="policy[dwelling_type]" id="policy_dwelling_type_unitapartmentflat_-_1st_floor" /><label tabindex="-1" for="policy_dwelling_type_unitapartmentflat_-_1st_floor">Apartment or Flat (First floor)</label>

    <input autocomplete="off" type="radio" value="Unit/Apartment/Flat - 2nd Floor" name="policy[dwelling_type]" id="policy_dwelling_type_unitapartmentflat_-_2nd_floor" /><label tabindex="-1" for="policy_dwelling_type_unitapartmentflat_-_2nd_floor">Apartment or Flat (Second floor)</label>

    <input autocomplete="off" type="radio" value="Unit/Apartment/Flat - 3rd Floor and above" name="policy[dwelling_type]" id="policy_dwelling_type_unitapartmentflat_-_3rd_floor_and_above" /><label tabindex="-1" for="policy_dwelling_type_unitapartmentflat_-_3rd_floor_and_above">Apartment or Flat (Third floor or above)</label>

    <input autocomplete="off" type="radio" value="Semi detached, duplex or terrace" name="policy[dwelling_type]" id="policy_dwelling_type_semi_detached_duplex_or_terrace" /><label tabindex="-1" for="policy_dwelling_type_semi_detached_duplex_or_terrace">Semi-detached, Duplex or Terrace</label>
</div>

    
    <div class="policy_construction_type">
  <label for="policy_construction_type">What are the external walls mostly made from?</label>
  <span>Please choose the option that applies to most of the property.</span>
  <input type="hidden" name="policy[construction_type]" value="" />
    <input autocomplete="off" type="radio" value="Brick Veneer" name="policy[construction_type]" id="policy_construction_type_brick_veneer" /><label tabindex="-1" for="policy_construction_type_brick_veneer">Brick Veneer</label>

    <input autocomplete="off" type="radio" value="Double Brick" name="policy[construction_type]" id="policy_construction_type_double_brick" /><label tabindex="-1" for="policy_construction_type_double_brick">Double Brick</label>

    <input autocomplete="off" type="radio" value="Concrete/Hebel" name="policy[construction_type]" id="policy_construction_type_concretehebel" /><label tabindex="-1" for="policy_construction_type_concretehebel">Concrete or Hebel<br><span class="hint">Including: Besser Block</span></label>

    <input autocomplete="off" type="radio" value="Hardiplank/Hardiflex" name="policy[construction_type]" id="policy_construction_type_hardiplankhardiflex" /><label tabindex="-1" for="policy_construction_type_hardiplankhardiflex">Hardiplank or Hardiflex</label>

    <input autocomplete="off" type="radio" value="Fibro/Asbestos" name="policy[construction_type]" id="policy_construction_type_fibroasbestos" /><label tabindex="-1" for="policy_construction_type_fibroasbestos">Fibro or Asbestos<br><span class="hint">Including: Blue Board, CFC Sheeting, Foam Sheeting</span></label>

    <input autocomplete="off" type="radio" value="Stone/Sandstone" name="policy[construction_type]" id="policy_construction_type_stonesandstone" /><label tabindex="-1" for="policy_construction_type_stonesandstone">Stone or Sandstone</label>

    <input autocomplete="off" type="radio" value="Weatherboard/Wood" name="policy[construction_type]" id="policy_construction_type_weatherboardwood" /><label tabindex="-1" for="policy_construction_type_weatherboardwood">Weatherboard or Timber</label>

    <input autocomplete="off" type="radio" value="Metal Sheeting" name="policy[construction_type]" id="policy_construction_type_metal_sheeting" /><label tabindex="-1" for="policy_construction_type_metal_sheeting">Metal Sheeting<br><span class="hint">Including: Permalum</span></label>

    <input autocomplete="off" type="radio" value="Metal Frame" name="policy[construction_type]" id="policy_construction_type_metal_frame" /><label tabindex="-1" for="policy_construction_type_metal_frame">Metal Frame</label>

    <input autocomplete="off" type="radio" value="Mudbrick" name="policy[construction_type]" id="policy_construction_type_mudbrick" /><label tabindex="-1" for="policy_construction_type_mudbrick">Mudbrick</label>

    <input autocomplete="off" type="radio" value="Other" name="policy[construction_type]" id="policy_construction_type_other" /><label tabindex="-1" for="policy_construction_type_other">Other</label>
</div>

    <div class="spacing-xx-tight policy_elevated">
  <label for="policy_elevated">Is the lowest part of your property structure 1 metre above the ground?</label>
  <span>Buildings are usually elevated to reduce the risk of damage from water</span>

  <div class="yes-no-options">
    <input type="hidden" name="policy[elevated]" value="" />
      <input autocomplete="off" type="radio" value="true" name="policy[elevated]" id="policy_elevated_true" /><label tabindex="-1" for="policy_elevated_true">Yes</label>

      <input autocomplete="off" type="radio" value="false" name="policy[elevated]" id="policy_elevated_false" /><label tabindex="-1" for="policy_elevated_false">No</label>
  </div>
</div>

    <div>
  <label for="policy_building_levels">How many levels (storeys) does the building have?</label>
  <input type="hidden" name="policy[building_levels]" value="" />
    <input autocomplete="off" type="radio" value="Single Level" name="policy[building_levels]" id="policy_building_levels_single_level" /><label tabindex="-1" for="policy_building_levels_single_level">Single level</label>

    <input autocomplete="off" type="radio" value="Double Level" name="policy[building_levels]" id="policy_building_levels_double_level" /><label tabindex="-1" for="policy_building_levels_double_level">Double level</label>

    <input autocomplete="off" type="radio" value="Three or More Levels" name="policy[building_levels]" id="policy_building_levels_three_or_more_levels" /><label tabindex="-1" for="policy_building_levels_three_or_more_levels">Three or more levels</label>
</div>

    <div class="policy_construction_type">
  <label for="policy_roof_type">What is the primary roof material?</label>
  <input type="hidden" name="policy[roof_type]" value="" />
    <input autocomplete="off" type="radio" value="Concrete Tiles" name="policy[roof_type]" id="policy_roof_type_concrete_tiles" /><label tabindex="-1" for="policy_roof_type_concrete_tiles">Concrete Tiles</label>

    <input autocomplete="off" type="radio" value="Terracotta Tile" name="policy[roof_type]" id="policy_roof_type_terracotta_tile" /><label tabindex="-1" for="policy_roof_type_terracotta_tile">Terracotta Tiles</label>

    <input autocomplete="off" type="radio" value="Metal/Colorbond" name="policy[roof_type]" id="policy_roof_type_metalcolorbond" /><label tabindex="-1" for="policy_roof_type_metalcolorbond">Metal/Colorbond</label>

    <input autocomplete="off" type="radio" value="Aluminium" name="policy[roof_type]" id="policy_roof_type_aluminium" /><label tabindex="-1" for="policy_roof_type_aluminium">Aluminium</label>

    <input autocomplete="off" type="radio" value="Concrete" name="policy[roof_type]" id="policy_roof_type_concrete" /><label tabindex="-1" for="policy_roof_type_concrete">Concrete</label>

    <input autocomplete="off" type="radio" value="Fibre/Fibro/Fibro tiles" name="policy[roof_type]" id="policy_roof_type_fibrefibrofibro_tiles" /><label tabindex="-1" for="policy_roof_type_fibrefibrofibro_tiles">Fibre/Fibro/Fibro tiles</label>

    <input autocomplete="off" type="radio" value="Asbestos Cement" name="policy[roof_type]" id="policy_roof_type_asbestos_cement" /><label tabindex="-1" for="policy_roof_type_asbestos_cement">Asbestos Cement</label>

    <input autocomplete="off" type="radio" value="Shingles" name="policy[roof_type]" id="policy_roof_type_shingles" /><label tabindex="-1" for="policy_roof_type_shingles">Shingles</label>

    <input autocomplete="off" type="radio" value="Slate" name="policy[roof_type]" id="policy_roof_type_slate" /><label tabindex="-1" for="policy_roof_type_slate">Slate</label>

    <input autocomplete="off" type="radio" value="Timber/wood" name="policy[roof_type]" id="policy_roof_type_timberwood" /><label tabindex="-1" for="policy_roof_type_timberwood">Timber/Wood</label>

    <input autocomplete="off" type="radio" value="Decramastic" name="policy[roof_type]" id="policy_roof_type_decramastic" /><label tabindex="-1" for="policy_roof_type_decramastic">Decramastic</label>

    <input autocomplete="off" type="radio" value="Other" name="policy[roof_type]" id="policy_roof_type_other" /><label tabindex="-1" for="policy_roof_type_other">Other</label>
</div>

    <div class="spacing-xx-tight">
  <div class="inline-link" data-controller="tooltip" data-action="click@window->tooltip#hide touchend@window->tooltip#hide">
    <label for="policy_year_built">In what year was the property built?</label>
    <a href="#" data-tooltip-target="trigger" data-action="click->tooltip#toggle">help</a>
    <div data-tooltip-target="content" class="tooltip" role="tooltip">
      <div data-popper-arrow></div>
      <a class="tooltip--close" data-tooltip-target="close" data-action="click->tooltip#hide">CLOSE</a>
      <p>If you do not know the exact date of build, please make a selection based on your best judgement. If you
        require assistance, please call us on <a href="tel:1800 804 016">1800 804 016</a></p>
    </div>
  </div>
  <select class="select-pretty" autocomplete="off" name="policy[year_built]" id="policy_year_built"><option value="">Select a year</option>
<option value="2026">2026</option>
<option value="2025">2025</option>
<option value="2024">2024</option>
<option value="2023">2023</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
<option value="1919">1919</option>
<option value="1918">1918</option>
<option value="1917">1917</option>
<option value="1916">1916</option>
<option value="1915">1915</option>
<option value="1914">1914</option>
<option value="1913">1913</option>
<option value="1912">1912</option>
<option value="1911">1911</option>
<option value="1910">1910</option>
<option value="1909">1909</option>
<option value="1908">1908</option>
<option value="1907">1907</option>
<option value="1906">1906</option>
<option value="1905">1905</option>
<option value="1904">1904</option>
<option value="1903">1903</option>
<option value="1902">1902</option>
<option value="1901">1901</option>
<option value="1900">1900</option>
<option value="1899">1899</option>
<option value="1898">1898</option>
<option value="1897">1897</option>
<option value="1896">1896</option>
<option value="1895">1895</option>
<option value="1894">1894</option>
<option value="1893">1893</option>
<option value="1892">1892</option>
<option value="1891">1891</option>
<option value="1890">1890</option>
<option value="1889">1889</option>
<option value="1888">1888</option>
<option value="1887">1887</option>
<option value="1886">1886</option>
<option value="1885">1885</option>
<option value="1884">1884</option>
<option value="1883">1883</option>
<option value="1882">1882</option>
<option value="1881">1881</option>
<option value="1880">1880</option>
<option value="1879">1879</option>
<option value="1878">1878</option>
<option value="1877">1877</option>
<option value="1876">1876</option>
<option value="1875">1875</option>
<option value="1874">1874</option>
<option value="1873">1873</option>
<option value="1872">1872</option>
<option value="1871">1871</option>
<option value="1870">1870</option>
<option value="1869">1869</option>
<option value="1868">1868</option>
<option value="1867">1867</option>
<option value="1866">1866</option>
<option value="1865">1865</option>
<option value="1864">1864</option>
<option value="1863">1863</option>
<option value="1862">1862</option>
<option value="1861">1861</option>
<option value="1860">1860</option>
<option value="1859">1859</option>
<option value="1858">1858</option></select>
</div>

    
    <div class="spacing-xx-tight policy_tenanted">
  <label for="policy_tenanted">Is your property currently tenanted?</label>
  <div class="yes-no-options">
    <input type="hidden" name="policy[tenanted]" value="" />
      <input autocomplete="off" type="radio" value="true" name="policy[tenanted]" id="policy_tenanted_true" /><label tabindex="-1" for="policy_tenanted_true">Yes</label>

      <input autocomplete="off" type="radio" value="false" name="policy[tenanted]" id="policy_tenanted_false" /><label tabindex="-1" for="policy_tenanted_false">No</label>
  </div>
</div>

    
    <div class="spacing-xx-tight policy_business_or_trade">
  <label for="policy_business_or_trade">Is there any business activity operated from your property?</label>
  <div class="yes-no-options">
    <input type="hidden" name="policy[business_or_trade]" value="" />
      <input autocomplete="off" type="radio" value="true" name="policy[business_or_trade]" id="policy_business_or_trade_true" /><label tabindex="-1" for="policy_business_or_trade_true">Yes</label>

      <input autocomplete="off" type="radio" value="false" name="policy[business_or_trade]" id="policy_business_or_trade_false" /><label tabindex="-1" for="policy_business_or_trade_false">No</label>
  </div>
</div>

    
    
    
    
    
    <div class="spacing-xx-tight policy_existing_customer" data-controller="inline-modal">
  <label for="policy_existing_customer">Are you a current Terri Scheer customer?</label>
  <div class="yes-no-options">
    <input type="hidden" name="policy[existing_customer]" value="" />
      <input autocomplete="off" type="radio" value="true" name="policy[existing_customer]" id="policy_existing_customer_true" /><label tabindex="-1" for="policy_existing_customer_true">Yes</label>

      <input autocomplete="off" type="radio" value="false" name="policy[existing_customer]" id="policy_existing_customer_false" /><label tabindex="-1" for="policy_existing_customer_false">No</label>
  </div>
</div>

    
  </span>

  <button name="refresh"
          class="hidden"
          formmethod="post"
          formaction="/policy_details"
          data-turbo="true"
          data-turbo-stream="true"
          data-refresh-form-target="button"
          data-address-find-target="disableWhenFinding">
    Refresh
  </button>

  <div>
    <button name="policy[submit]" type="submit" id="policy_submit" class="button button-continue float-right" data-turbo="false" data-address-find-target="disableWhenFinding">
      <span>Continue</span>
</button>  </div>
</form>
</template></turbo-stream>