House
Insurance Quotation Request
About You...
Proposer's Name
E-mail address
Postal address
Postcode
Telephone No
Your occupation
Your date of birth
Marital status
Married
Single
if married please give
your spouse's date of birth
Spouse's occupation
Present Insurer
Date of expiry of
present insurance
Have you had any
claims or losses in the last 5 years?
Yes
No
if yes, please give
details including dates
About
the property
Address of the property
to be insured (if different from that previously supplied)
Postcode
What year was the
property built?
Is the property to
be insured
please select one >>>
Private dwelling house
Bungalow
Purpose built flats
Single private flat
Conversion to flats
Other conversion
If the property is
a house, is it...
please select one >>>
Detached
Semi-detached
Terraced
No of bedrooms
Constructed of
please select one >>>
Brick
Stone
Concrete
Roof
please select one >>>
Slate
Tile
Metal
Asphalt
Concrete
Is the property
please select one >>>
Owned - mortgaged
Owned outright
- not let
Rented from private
landlord (furnished)
Rented from private
landlord (unfurnished)
Rented from Local
Authority (furnished)
Rented from Local
Authority (unfurnished)
Does the property
have a garage?
Yes
No
if yes is the garage
please select one >>>
Detached, built of
brick/stone
Detached, not brick
or stone
Attached, built of brick/stone
Attached, not brick/stone
Integral
if not brick or stone,
what is the garage's construction?
Is the property a
listed building?
Yes
No
Is the property situated
close to cliffs, quarries, rivers etc?
Yes
No
if you have answered
'yes' to the above, how close?
please select one >>>
under 20 metres
20 to 50 metres
over 50 metres
Please
confirm the following about the property:-
The property is in
a good state of repair
Yes
No
Is in a flood free
area
Yes
No
Has a self contained
entrance
Yes
No
Is in an area free
from subsidence, heave and landslip
Yes
No
Has not been pinned
Yes
No
If you have answered
'no' to any of the above please call us free on
0500 401226
About
the property occupancy
Total number of occupants
Are any of these
people not members of your family?
Yes
No
How many occupants
are there under 18 years of age?
Approximately, how
many hours per day is the property unoccupied
hours
Approximately, how
many hours per night is the property unoccupied?
hours
Is the property or
any part of it occupied for business purposes
Yes
No
if yes, please give
details
About the buildings
cover
What is the rebuilding
cost of the property?
Do you require accidental
damage cover for the buildings?
Yes
No
If you do not
require contents insurance click here ,
otherwise complete the fields below
Contents Cover
How much cover do
you require
Please check which of the following
you wish to include and give the required sum insured
Description
Required?
Sum insured
Freezer foods
Money
Credit cards
Do you wish to include
any specified items on the policy?
Yes
No
if yes, please enter
descriptions and values
Do you wish to include
accidental damage cover on the contents insurance?
Yes
No
Alarm
Info
Does the property
have an alarm?
Yes
No (if no, please click here )
Type of alarm
please select one >>>
999 line
Bell
Central Station
Alarm (no code)
NACOSS
Unknown
Was the alarm professionally
installed?
Yes
No
By whom?
Does the alarm system
have a maintenance contract?
Yes
No
Further
Information
Do you have any no
claims discount (NCD) realting to the buildings cover?
Yes
No
if yes, how much
%
or
years
Do you have any no
claims discount (NCD) realting to the contents cover?
Yes
No
if yes, how much
%
or
years
Please state your
required voluntary excess
please select
None
£50
£100
£250
Preferred Payment
Method
choose >>>
Credit Card
Debit Card
Cheque
Direct Debit