Please fill out the form below to find out if we can offer you a better deal on your buildings and/or contents insurance.  In order for us to process your enquiry quickly please give as much information as possible.


Personal Details
Name 
Sex 
Email Address 
Daytime Contact Number 
Postcode 
Marital Status 
Occupation 
Date Of Birth 
Resident in the UK since 
 
Your Home  
 Type of Property
 Ownership
 If rented, how long is you tenancy agreement?
 What year was the property built?
 How many bedrooms?
 Is the property occupied solely by you and your  family? Yes  No
If no give details below:
 Will your home be left unoccupied for more than 30  days at any time? Yes  No
 Is the property occupied during normal working  hours? Yes  No

Buildings  
 Sum Insured Required (estimated rebuilding cost)
 Do you wish to include cover for accidental  damage? Yes  No
 What excess do you require for normal claims  (excluding subsidence)

Contents (cover for items within the home)  
 Sum Insured Required (Estimated cost to replace)
 What excess do you require?
 What amount, out of the sum insured requested,  represents items in the following categories:  
 1. Stamp, coin or medal collections, curios,  pictures, works of art. 1.
 2. Articles of gold, silver, other precious metals or  jewelry? 2.
 3. Computer, TV, Video and HiFi equipment and  peripherals/software? 3.

All Risks (wider Cover for your possessions taken away from home)  This cover is only available where you are also insuring your contents.  
 Please advise sum insured required for unspecified  items not exceeding £1,000 individually.
 Please list any items for which All Risks cover is  required which exceed £1,000 individually e.g. gold  watch, £1,500

Pedal Cycles  
 Pleas state maximum value and number of cycles: Number: Value:

Discounts available  
 Please state property fitted with burglar alarm Yes  No
If yes, do you have a maintenance contract with a NACOSS approved installer  Yes  No
 Is your property in a police recognised  Neighborhood Watch Scheme? Yes  No
 Is your property fitted with window locks on ground  floor and accessible upper floor windows? Yes  No

Claims History  
 Please give details of your previous insurance  claims or losses under a household insurance  policy    (Please include date, circumstances and  approximate cost) 

Other Information  
 We will assume, unless you state otherwise blow, that:
  • Your property is in a good state of repair and will be so maintained
  • Your property is not a holiday home
  • Your property is not a listed building
  • Your property is of standard construction, i.e built of brick or stone and roofed with slates, tiles, metal or concrete.
  • Your property is in an area not susceptible to floods or subsidence.
 Please use this box to give any other information  which you feel may be of use in calculating our   best premium.


 

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