Holiday Home Insurance

Policyholder Details

Title First Name Surname

Please enter your correspondence address:

Number Street Town

County Post Code

Home Tel Work Tel Fax No

E-Mail

How would you like to be notified of your quote?

Date cover is required from

Occupation (Bricklayer) Business (Building Trade)

Employment Status Date of birth

Property Details

Please enter the details of the property to be insured:

Number Street Town

County Post Code Country

Buildings Sum Insured (if required) Is Accidental Damage Cover Required

Contents Sum Insured (if required) Is Accidental Damage Cover Required

Do you require Subsidence Cover

Type of Occupancy

Are the premises used as a holiday residence by you and your family

Are the premises sublet as a holiday home by you or via an agent

Is the property let out for more than 6 months of the year in total

Construction Details

Year the property was built

What type of property is it

Number of Flats/Units in whole building Number of Flat/Units to be insured

Number of storeys (including attic/basement)

What construction is the buildings (i.e. Brick, Stone, Timber, etc)

What construction is the roof (i.e. Slate, Tile, Felt, etc)

If the roof is felt or bitumen, when was it last renewed

What percentage of the roof is flat If there is any flat roof, how old is it

Claims

Have you made any claims on this or any other property in the last 5 years

If yes, complete the form below with the most recent claims first:

	Claim 1	Claim 2	Claim 3
Date of claim
Type of claim
Please provide full details of claim (i.e. Fire, Theft, etc.)
Was claim at the property to be insured
Cost of claim (estimate if not sure)

Security

Are all external doors protected by a 5 Lever Mortice Deadlock

Have all accessible windows got key operated locks

Final Questions

Does the property have any history of Storms, Flooding, Subsidence, Lanslip or Heave

Are there any trees over 3 metres tall within 3 metres of the Building

Have you been convicted of, or in the course of being charged with, any offence (excluding driving offences)

Have you been declared bankrupt or been a director of any company that went into liquidation

Have you had any insurance declined, cancelled, refused or had any special terms applied by any Insurer for the risks proposed

If you have answered "Yes" to any of the three questions above, please provide full details in the additional information section below.

Which search engine did you find us on

Best Quote so far

Please add any additional information that may be required for your quotation in the space below

Thank you for taking time to fill out this form. Please ensure that all required details have been completed (you will be prompted to complete the sections you have missed) and double check that your e-mail address is correct if this is your chosen method of reply or we may not be able to return your quote. Please then press the submit button below to send your details to us, wait for the confirmation page to load and you will then be contacted with your quotation as soon as it is processed.