Renewal date / Cover date:

Renewal premium:

Where did you hear about us?

Title:

I chose ‘Other’ my title is:

First Name:

Surname:

Date of birth:

Occupation:

Is the proposer a:

If the policy is to be in the name of a company/residents association, 
please state the name of the company/residents association:

Preferred method of contact:

Contact telephone number:

Email address:

Are the flats:

House name / number:

Postcode

Year of conversion (if applicable)

Year property built (Approximately)

Year property was purchased:

Construction of the property:

Number of flats:

Number of storeys:

Is the floor:

Are the stairs:

What percentage of the roof is flat (If applicable):

Is the property:

If any of the flats are unoccupied, please state how many:

Are the flats:

If any of the flats are let, how many are currently let out (If known):

If any of the flats are let, please state the type of tenants occupying the flat(s), ie working professionals/retired, DSS claimants, students or asylum seekers:

Rebuild value of the property:

Do you require accidental damage cover for the buildings:

Any convictions or criminal offences or pending prosecutions:

Ever been declared bankrupt/insolvent or the subject of bankruptcy proceedings:

Ever had a proposal refused or declined or had an insurance cancelled, renewal refused or had special terms imposed:

Is the property located within 400m of any watercourse, or has the property ever suffered from flooding:

Is the property currently undergoing structural renovation, or is any structural work (excluding interior decorating) planned during the policy term?:

Has the property ever suffered any obvious damage from subsidence or show any visible signs of cracking, or has the property ever been underpinned:

Have you made any claims against the buildings or contents insurance for this, or any other property, within the past five years:

If you have answered yes to any of these questions, please give details below, detailing dates, circumstances and if a claim, the settlement amount.

Please check all of the details. Once you are happy with the information provided, please click the submit button.

We will be in contact as soon as we have obtained a quotation. Thank you.

Renewal date / Cover date:

Renewal premium:

Where did you hear about us?

Title:

I chose ‘Other’ my title is:

First Name:

Surname:

Date of birth:

Occupation:

Title:

I chose ‘Other’ the title is:

First Name:

Surname:

Date of birth:

Occupation:

Preferred method of contact:

Contact telephone number:

Email address:

House name / number:

Postcode

Year property built (Approximately)

Year property was purchased:

Construction of the property:

What percentage of the roof is flat (If applicable):

Is the property:

What type of property:

If the property is a flat,
what floor is it on?:

How many bedrooms:

Rebuild value of the property:

Do you require accidental damage cover for the building:

Contents sum insured:

Do you require accidental damage cover for contents:

If you have any valuables or single items worth over £1,500,
please list them:

Do you require ‘All risks’ cover for items taken out of the home:

If yes, please specify the amount of unspecified personal possessions taken away from the home:

If you have any specified items taken away from the home valued over £500, or require cover for any pedal cycles, money, mobile phone or freezer contents, please list them here:

Are all external doors fitted with five lever mortice deadlocks:

Are all accessible windows fitted with locks:

Is there an alarm fitted to the property:

If yes, please state what type, eg bells only, Redcare

Any convictions or criminal offences or pending prosecutions:

Ever been declared bankrupt/insolvent or the subject of bankruptcy proceedings:

Ever had a proposal refused or declined or had an insurance cancelled, renewal refused or had special terms imposed:

Is the property located within 400m of any watercourse, or has the property ever suffered from flooding:

Is the property currently undergoing structural renovation, or is any structural work (excluding interior decorating) planned during the policy term?:

Has the property ever suffered any obvious damage from subsidence or show any visible signs of cracking, or has the property ever been underpinned:

Have you made any claims against the buildings or contents insurance for this, or any other property, within the past five years:

If you have answered yes to any of these questions, please give details below, detailing dates, circumstances and if a claim, the settlement amount.

Please check all of the details. Once you are happy with the information provided, please click the submit button.

We will be in contact as soon as we have obtained a quotation. Thank you.

Renewal date / Cover date:

Renewal premium:

Where did you hear about us?

Title:

I chose ‘Other’ my title is:

First Name:

Surname:

Date of birth:

Occupation:

Title:

I chose ‘Other’ the title is:

First Name:

Surname:

Date of birth:

Occupation:

Preferred method of contact:

Contact telephone number:

Email address:

House name / number:

Postcode

Year property built (Approximately)

Year property was purchased:

Construction of the property:

What percentage of the roof is flat (If applicable):

What type of property:

If the property is a flat,
what floor is it on?:

If property is let, please state the type of tenants occupyingthe property, ie working professionals/retired, DSS claimants, students or asylum seekers

How many bedrooms:

Is the property

Rebuild value of the property:

Contents sum insured:

If you have any valuables or single items worth over £500,
please list them:

Do you require ‘All risks’ cover for items taken out of the home:

If yes, please specify the amount of unspecified personal possessions taken away from the home:

If you have any specified items taken away from the home valued over £500, or require cover for any pedal cycles, money, mobile phone or freezer contents, please list them below:

Are all external doors fitted with five lever mortice deadlocks:

Are all accessible windows fitted with locks:

Is there an alarm fitted to the property:

If yes, please state what type, eg bells only, Redcare

Please give details of any currernt or pending criminal convictions relating to anyone living in the property. Please give details of date of offence(s), nature of offence(s) and penalty/sentence imposed

Ever been declared bankrupt/insolvent or the subject of bankruptcy proceedings:

Ever had a proposal refused or declined or had an insurance cancelled, renewal refused or had special terms imposed:

Is the property located within 400m of any watercourse, or has the property ever suffered from flooding:

Is the property currently undergoing structural renovation, or is any structural work (excluding interior decorating) planned during the policy term?:

Has the property ever suffered any obvious damage from subsidence or show any visible signs of cracking, or has the property ever been underpinned:

Have you made any claims against the buildings or contents insurance for this, or any other property, within the past five years:

If you have answered yes to any of these questions, please give details below, detailing dates, circumstances and if a claim, the settlement amount.

Please check all of the details. Once you are happy with the information provided, please click the submit button.

We will be in contact as soon as we have obtained a quotation. Thank you.