Complete our House Insurance Form

PROPOSER

Proposer *

Date of Birth *

Occupation *

Email *

PROPERTY DETAILS

Address to be insured including postcode *

Is the property in a good state of repair? *
YesNo
No of occupants (above/under 18)

Is the property unoccupied in the day or night?
usually occupied day and nightunoccupied during the dayunoccupied overnight
Are any occupants smokers?
YesNo
No of bedrooms *

No of bathrooms *

Year property was built

Type of property *

Wall type *

Roof type *

Percentage of roof that is flat

Is the property used for business?
YesNo
What kind of locks do you have on your windows and external doors?

Does the property have a security alarm?
YesNo
Does the property have any fire precautions?
YesNo
Who owns the property? *

Is there an interested party i.e. mortgage holder
YesNo
Is the property within 400 metres of a river or quarry?
YesNo
Has the property experienced landslip, subsidence, heave?
YesNo
Have any special terms or conditions ever been applied to insurance for this property?'

Number of years claim free *

SUMS INSURED

Buildings cover required *

Is accidental damage cover required?*
YesNo
Detail any claims you have made in the past 5 years

Contents cover required

Total sum of specified items within contents cover *

Unspecified items away from home

Specified items away from home

Number of years claims free

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