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About You |
| 1. |
Contact name
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| 2. |
Correspondence address
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Postcode
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| 3. |
Telephone number
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| 4. |
Email
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| 5. |
Role
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Policyholder |
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| 6. |
Full name of Insured Party/Parties
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- (If personal policyholder) Permanent residential address for each insured party
- (If corporate/organisation policyholder) Preferred correspondence address
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(If corporate/organisation policyholder) Company Number:
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The Insured does not reside in the United Kingdom
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Property Details |
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| 7. |
Risk Address
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Postcode
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| 8. |
Construction Details
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• Property style:
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• Wall construction:
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• Roof construction:
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◦ Approximate percentage of roof area that is flat (If no area of the roof is flat, please enter 0):
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• Floor construction:
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• Stairs construction:
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• Cladding construction (if applicable):
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• Number of storeys:
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• Number of lifts:
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• The property has a basement:
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• Date of construction:
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• Grade listing (if applicable):
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• The property has an oil tank:
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• The property is in a good condition and will be maintained as such:
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• All statutory and safety regulations are being complied with:
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• Declared Value/Rebuild Cost of property
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• Commercial Loss of Rent (annual figure):
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◦ Loss of Rent Indemity Period:
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• If applicable, Residential Loss of Rent will be included automatically, free-of-charge, as per the policy wording.
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Commercial Occupation |
| 9. |
Full details of commercial occupants' trade(s):
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Residential Occupation |
| 10. |
The property has residential portions
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| 11. |
Number of flats
If the property has no flats, or has a different kind of residential accomodation, please enter 0.
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| 12. |
(If the property has flats) Are any flats sold or leased out other than directly to long-term leaseholders, or under an Assured Periodic Tenancy agreement?
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Claims & Incidents |
| 13. |
Last 5 years' history of all Claims, Incidents, and Losses
(If none, please state so)
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| 14. |
Has the property ever suffered from any of the following?
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Subsidence/Heave/Landslip
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Fire
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Flood
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Cracking
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Details
(If you answered yes to any of the above)
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Previous Insurance |
| 15. |
Existing Insurers
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| 16. |
Insurance Renewal Date
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| 17. |
Premium
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- Leave this field blank if this is your first policy.
- Include all applicable taxes.
- Use the combo box to the right to specify whether this is the Expiring premium or the Target premium.
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This premium figure includes:
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Terrorism Cover
Engineering Cover
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| 18. |
Additional details
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Please select any add-on covers you would like to be included in your quote: |
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Terrorism Cover
Engineering (Lift Insurance & Inspection) Cover
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You will have a chance to confirm which add-on covers to include if and when you take out your policy. |
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