Household Insurance Quotation
Please complete all required fields in-order for us to provide a quotation
Personal Details
Name
Mr
Dr
Mrs
Miss
Ms
Address to be Insured
Post/Zip Code
Tel
Fax
Email
Property Details
Property Ownership
Mortgaged
Owned
Council Rental
Private Rental
Shared Ownership
Number of Bedrooms
Property Type
Detached
Terraced
Semi-Detached
Other
House
Bungalow
Flat
Maisonette
Other
Construction
Walls
Brick
Stone
Concrete
Timber Framed
Roof
Tiled
Slate
Flat Felted
Metal
Year Built
Is the Property Listed
Yes - Grade I
Yes - Grade II
No
Cover Required
Buildings
Sum Insured
Accidental Damage Required
Yes
No
Contents
Sum Insured
Accidental Damage Required
Yes
No
Away from Home Cover
Sum Insured
No. of Bicycles
Items over £1,000
Sum Insured
Please provide details of all items over £1,000
Is Family Legal Cover Required?
Yes
No
Is Claims Handling Service Required?
Yes
No
Who is your Current/Previous Insurer
When would you like cover to start
(this should be your renewal date)
Please provide answers to the following (Discounts may apply)
Do you live in a Neighbourhood Watch Area?
Yes
No
Do you have an alarm installed?
Yes
No
Do you have a NACOSS alarm?
Yes
No
Do you have 5 Lever Mortice deadlocks installed on all external doors?
Yes
No
Do you have removable key locks on all accessible windows?
Yes
No
Are you or any other occupants smokers?
Yes
No
Please state the number of occupants
Underwriting Questions
Is this your main residence and not let or occupied by paying guest/tenants?
Yes
No
Are there any trees within 5 metres of the main dwelling or outbuildings?
Yes
No
Has the property been affected by subsidence, structural movement, or is it in a subsidence area?
Yes
No
Is the property used for business purposes?
Yes
No
If yes, please provide details including type of business and number of visitors per day:
Have you or anyone residing with you, had any special terms or conditions imposed by an insurer?
Yes
No
Is your home left unoccupied for more than 30 consecutive days?
Yes
No
Does your property have patio doors?
Yes
No
Has your home been damaged by flood and/or is in an area liable to flooding?
Yes
No
Have you or anyone residing with you, had insurance refused, cancelled or declared null & void?
Yes
No
Have you or anyone residing with you, been declared bankrupt, suffered liquidation, had CCJ's imposed or had any other form of financial or legal problem?
Yes
No
If Yes, please provide details:
Claims History
Have you or anyone residing with you, suffered loss or damage within the last 5 years, whether a claim was made or not?
Yes
No
If yes, please provide the following information:
Date of Claim:
£
Claim Settlement Amount:
£
Reason for the Claim:
If you have suffered more than 1 claim within the last 5 years, please provide all relevant details in the Section below:
Declaration and Further Comments
Please provide any further comments in the space provided below
Our quotation is based on the answers you have provided above. By clicking on the submit button, you are confirming that the answers provided by you are true and accurate to the best of your knowledge.
Thank you.
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