Works Questionnaire

Please answer the questions carefully and to the best of your knowledge, as our quotation will be based on the details you provide. Incorrect information could lead to an increased premium, claim being declined or invalidate an insurance.

Step 1 of 2 - Your details

Our reference number?*

Enter 9 digit number, found at the top of emails and letters from Ember JD. If 8-digits please start number with zero

Your details

Policyholder's name?*

Title First name Surname

Email address?*

Enter email Confirm email

Address of property to be insured?*

Enter postcode, click find address, select from drop-down

Postcode 1st line 2nd line Town / city Postcode

When are the works expected to commence?*

How long are the works estimated to take?*

What is the estimated cost of the works?*

Describe the nature of the works proposed here?*

Will the property be occupied by you the policyholder for the duration of the works contract?*

Is planning permission required for any part of these works?*

Has planning permission been applied for?*

Has planning permission been granted?*

As planning permission has been declined, please give reasons here*

Will all contractors employed have sufficient public liability insurance in place with an indemnity limit of at least £1 million or to a limit that exceeds your buildings sum insured?*

Have you entered into any Joint Contracts Tribunal Contracts?*

Please give details here, including the relevant edition and clause which have been agreed:*

This field is hidden when viewing the form

IMPORTANT INFORMATION WHICH MUST BE READ IN FULL

The information contained in this Statement of Fact forms the basis of your policy and is fundamental to the risk assumed by the Insurers. You must notify Ember JD immediately if any of the above details are incorrect as your cover might be invalidated if you do not.
Misrepresentation
We declare that to the best of my knowledge and belief the information I/We have provided in connection with this proposal to Ember JD, whether in my own hand or not, is true and complete and I/We have not withheld or misrepresented any information. I/We ask underwriters to act upon the information provided and issue a contract of insurance between us and I/We agree to accept underwriter’s policy terms, conditions and exclusions. I/We consent to the seeking of information from other insurers to check the answers I/We have provided and I/We authorise the giving of such information for such purposes. I/We understand that if I/We have withheld or misrepresented any of the information contained in this proposal, underwriters may be entitled to void the insurance.
Data Protection Act 1998
By accepting this Statement of Fact you consent to Ember JD using the information we may hold about you for the purpose of providing insurance and handling claims, if any, and to process sensitive personal data about you where this is necessary (for example, health information or criminal convictions). This may mean we have to give some details to third parties involved in providing insurance cover. These may include insurance carriers, third party claims adjusters, fraud detection and prevention services, reinsurance companies and insurance regulatory authorities. Where such sensitive personal information relates to anyone other than you, you must obtain the explicit consent of the person to whom the information relates both to the disclosure of such information to us and its use by us as set out above. The information provided will be treated in confidence and in compliance with the Data Protection Act 1998. You have the right to apply for a copy of you information (for which we may charge a small fee) and to have any inaccuracies corrected.
Basis of Cover
I understand that my acceptance of this Statement of Fact does not bind me to complete the insurance but agree that, should a contract of insurance be concluded, this Statement of Fact and the statements made in it and the information provided in connection with it will be relied upon by the underwriters in deciding whether to accept this insurance.
Your records
You should keep a record (including copies of any letters) of all information supplied to Ember JD for the purpose of entering into this insurance.
Change in Circumstance
You must inform Ember JD of any change in circumstances which may affect this insurance. If you are in any doubt you should consult Ember JD Insurance Brokers.
E.U. Disclosure Clause (UK)
Notice to the Proposer / Insured: The parties are free to choose the law applicable to this insurance contract. Unless specifically agreed to the contrary this insurance shall be subject to English Law.
Complaints
Any enquiry or complaint should be addressed in the first instance to your broker, Ember JD. The process for complaining directly to Lloyds can be found in the Complaints section of your Policy Wording.
The Financial Ombudsman
If you are still not satisfied with the way a complaint has been dealt with you may ask The Financial Ombudsman to review your case without prejudice to your rights in law. You can contact The Financial Ombudsman at:
The Financial Ombudsman Service
Exchange Tower
London
E14 9SR
Telephone: 0800 023 4567
www.financial-ombudsman.org.uk.

Your details

Property types

○ Flats Insurance
○ Maisonettes Insurance
○ RTM Insurance

Occupancy types

○ Home & Annexe Insurance
○ Let Home Insurance
○ Unoccupied Home Insurance

Specific types

○ Home & Garden Room Insurance
○ Leaseholders Insurance
○ Single Flat Buildings Insurance

Your details

Property types

○ Flats Insurance○ Maisonettes Insurance○ RTM Insurance

Occupancy types

○ Home & Annexe Insurance○ Let Home Insurance○ Unoccupied Home Insurance

Specific types

○ Home & Garden Room Insurance○ Leaseholders Insurance○ Single Flat Buildings Insurance

○ Flats Insurance
○ Maisonettes Insurance
○ RTM Insurance

○ Home & Annexe Insurance
○ Let Home Insurance
○ Unoccupied Home Insurance

○ Home & Garden Room Insurance
○ Leaseholders Insurance
○ Single Flat Buildings Insurance