Buildings & Contents Insurance - Quotation Request

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

Further Information

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

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