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Your details

Provide your contact details

Name

Telephone

Correspondence address

Type of Quotation

Choose from the following:

Test:In what capacity are yor acting?

In what capacity are you acting?

1 - I am the: 2 - I am the legal professional acting on behalf of the :

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Date Policy is required from?

Policyholder details

Please provide the details of the policyholder

Name of Policyholder

Date of Birth for Property owner/ Deceased?

Occupation of the Property owner?

Test:The property Details

Property Information

Note - If you don't know the answer to any of these questions, please leave it blank.

Address to be insured

Property type (select from the list)

Year of Construction

Number of bedrooms

Length of time unoccupied

Is the property in a good state of repair? (Weather tight, secure and structurally sound)

Buildings sum insured / Reinstatement cost.

Contents sum insured required.

Are you planning any works or alterations at the property in the next 12 months?

Test:For Flats

For Flats

If quotation is for a single flat, is the proposer the

Is there a management company or resident’s association?

Policyholder details

Other information

Important additional information about the property/policy

Has the property or its grounds been flooded at any time?

Does the property to be insured have any history of subsidence, heave, landslip or has it been underpinned?

Has the proposer, or the risk address suffered any loss, damage or claims during the past 5 years?

Has any proposer or other person residing at the risk address been convicted of or has any criminal offences which are not spent under the rehabilitation of offenders act or has any prosecutions pending other than motoring offences?

Has any proposer or other person residing at the risk address been the subject of bankruptcy proceedings, CCJ or IVA?

Additional Information

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Type of Quotation

In what capacity are you acting?

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Property Information

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