Home Contents & Buildings Insurance Quotation   

Personal Details          Your email address:  

Commencement date of cover

Telephone Number

Best time to contact you

Age or Date of Birth  Spouse  Born  

Occupation Occupation Spouse:

Property Detail

Address:      

Post Code:

Sum Insured Buildings  £  Accidental  Damage Cover:  Yes No

Sums Insured Contents  £  Accidental Damage Cover    Yes No

Approximate year property Built  Is property Thatched?    No Yes

Number of Bedrooms   Four Five or more Five Three Two One         Permanent Residence   Yes No

Is the house normally occupied during the day? Yes No

Type of property House (Detached) House (Semi Detached) Bungalow (Detached) Bungalow (Semi Detatched) Terraced Thatched Cottage Flat (Self Contained)

Is Property in good state of repair? Yes No

Occupied by family?   Yes No

If property let,  to whom? Students DSS referrals Long Term Tenants Owner Occupied

CLAIMS HISTORY

How may claims made during last 5 years? None One Two Three Four Five

Please advise details of claims

Does your property show signs of Heave or Subsidence?   No Yes

Have you ever been refused insurance?                             No Yes

Have you ever been convicted?                                         No Yes

SECURITY

Is your property alarmed? Yes No if so is it NACOSS  approved? Yes No

Would you like an alarm quotation?                              Yes No

Does your property have Window Locks?                   Yes No

Are your a member of a N/Hood Watch Scheme?       Yes No

ALL RISKS SECTION

Sums Insured for "All Risks" personal posessions  £ 

Items of specific value that you would like itemised on policy

Pedal Cycles Number None One Two Three

Do you require Deep Freeze Contents Cover? Yes No

Do you require sports equipment cover? Yes No Sum Insured ? 

Type of Sport?

Do you require Family Legal Protection?      Yes No

Have you ever been declined cover?            No Yes

Have you ever been convicted?                   No Yes

Will your property be left unoccupied for periods of more that 30 days No Yes

Identify specific areas of cover that may cause you concern?

Signed:

Title  First  Surname

POST BOX

Incomplete applications cannot be processed. Your quotation will be e-mailed

Thank You      

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