Home Insurance

Claims

Have you made any claims on this or any other property in the last 5 years No Yes

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

Property Details

Type of property Detached End Terraced Ground Floor Mid Terraced Other Floor Semi Detached Bungalow Flat (Converted) Flat (Purpose Built) House Maisonette (Converted) Maisonette (Purpose Built)

Date you became resident

Year the property was built Number of Bedrooms

Wall Construction Roof Construction

Percentage of Total Roof which is flat

How many people occupy the house How many of these are under 18

Ownership type Owned On Mortgage Owned Outright Rented From Local Authority Rented From Private Landlord Tied Occupancy Let Furnished Let Unfurnished Not Let Rented Furnished Rented Unfurnished

Occupancy Status Holiday Home Let To Others Permanent Home Weekday Home Weekend Home Listed Building Grade 1 Listed Grade 2 Listed Not Listed Preservation Order

Has your home been extended, other than for a conservatory, which has resulted in more than a 10% increase in the original floor area? No Yes

Is the home occupied solely by you and your family No Yes

Is it used for any business purposes No Yes

Is the home self-contained with separate lockable entrance under your control No Yes

Is the property unoccupied: During The Day No Yes During The Night No Yes

What is the maximum number of consecutive days the property is left unoccupied

Do you have an approved burglar alarm fitted No Yes

If yes, please provide full details of alarm (i.e. NACOSS, audible only, etc)

Do you have approved locks fitted (i.e. 5 lever mortice) No Yes

Do the premises have exterior security lighting? No Yes

Are the security devices activated at night or when the property is unoccupied? No Yes

Do you agree to always use such devices for a possible premium discount No Yes

Are you a member of an approved Neighbourhood Watch scheme No Yes

Are there any smoke detectors No Yes

Is there a safe at your property No Yes

Cover

Please complete one or both of the following two sections (i.e. Buildings Only, Contents only or Buildings and Contents)

Contents

Contents Sum Insured (if required)

Is accidental damage required Please Specify No Yes

Number of claim free years earned on Contents Insurance

Value of the most expensive item kept in the home

Do you require cover on contents outside the home Please Specify No Yes

If yes, what sum insured is required for them

Please list all items over £1000 and their individual values

Buildings

Buildings Sum Insured (if required)

Is accidental damage required Please Specify No Yes

Number of claim free years earned on Buildings Insurance

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.