Title
Name*
Date of Birth*
Occupation*
Type of Company*
Address to be insured (including Postcode)*
Contact Telephone Number
E-mail Address*
Property Details Including Outbuildings
4) Year of construction*
5) How long have you lived at this property?*
6) Property type (i.e. detached, terraced etc. Specify floor if a flat)*
7) Number of bedrooms*
8) Acreage and usage of land*
9) What is the construction of the walls and roof of your property (including any outbuildings)?
10) Is there any area of flat roof? If so what % of the total roof and what composition? (felt/timber/lead or other)*
11) Listed status (if applicable)*
13) Is there any history or signs of Subsidence, Heave or Landslip (e.g. any cracking or underpinning)? If yes please provide details*
14) How far is the property from the nearest watercourse?*
15) What height is the lowest part of the property above the nearest watercourse?*
16) Have the gardens, grounds or local area ever flooded, including run off of rainwater? If yes please give details*
17) Are the premises used for any business purposes? If yes please give details including any visitors and frequency, any stock and any employees on the premises*
18) Are there any events held at the premises (e.g. open gardens, charity events etc)? If yes please provide details*
19) Are there any building works planned within the next 12 months? If yes please give details*
20) Please provide any details of any trees or shrubs within 7 metres of your home that are more than 3 metres tall (type, distance from property & height):*
21a) Please provide details of oil tank or other heating method here*
22) Please give details of any losses or claims in the last 6 years. If none, state total number of claim free years.*
25a) Please give details of smoke detectors (battery/mains/integrated with to alarm, list any fire extinguishers and fire blankets)*
26) How far is the property from the nearest fire brigade? (miles)*
27a) If no, please provide details:
28a) If no, please provide details:
29a) If no, please provide details:
31) If yes, please provide details of make, model and cash rating
31a) Please give details of any other notable security (if applicable)
Sums Insured - please add total sums insured for each applicable category
What is the main building(s) rebuild sum insured?
What is the outbuildings sum insured?
What is the general contents sum insured?
Paintings sum insured
Antique furniture sum insured
Porcelain/glass sum insured
Sculptures (non-fragile) sum insured
Rugs & Tapestries sum insured
Coin Collections sum insured
Gold/Silver/Precious Metals sum insured
Clocks & Barometers sum insured
Books sum insured
Wine sum insured
Stamp Collection sum insured
Please use this section to provide details of any specified items (including year of last valuation) or any other items not listed above
Valuables - please provide sums insured for the following:
Unspecified Jewellery & Watches
Specified Jewellery & Watches
Jewellery & Watches kept in safe
Jewellery & Watches kept in bank or safe deposit
Furs
Guns
Please use this space to provide details of any specified items including year of last valuation
Additional Details
Renewal Date*
Policy Excess*
Current Insurer*
Current Premium
Period with current insurer
Please Provide Details Of The Number Of Travelers, Their Ages And If They Are Still Dependent/Living At Home:
If yes, please give details:
Submit