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Get a Quote: Home & Contents Insurance

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Title First name Surname Date Of Birth Contact Telephone Number Email Address Occupation/Precise Nature of Business Is this a joint application? First name Surname Date Of Birth Post Code House Number or Name Street Name 2nd line of address Town
Are you looking to obtain Is this the address you wish to insure? Address of Property to be insured: Post Code House Number Street Name 2nd line of address Town
Is the property subject to mortgage? Name of Lender Mortgage reference Property type Please provide details Is it self contained having its own lockable entrance under your sole control? Is it purpose built? Which floor is it on? Are the premises situated above or part of commercial premises? Are commercial premises used as any of the following? If other, please specify Are you permanently living in the home and not using it in any way as part of a business, trade or profession? For which business, trade or profession is the premises being used? Please specify Is the home regularly left unattended at night? Is the home vacant or will it be left unattended for more than 30 days? Please provide details Solely constructed from brick, stone or concrete? Please give details Roofed solely with slate, tiles or concrete? Please give details Is any part of the roof flat felt and bitumen roofing? What percent? Does the property have a thatched roof?
What is the construction method of the flooring? Please specify Is the home in a good state of repair? Please give details Are the premises free from flooding, in an area which is free from flooding and not near any rivers, streams or tidal waters? Please give details Are the buildings free from signs of internal or external stepped or diagonal cracking? Please give details Are the buildings being monitored for subsidence, heave or landslip; have they ever been monitored for subsidence, heave or landslip, or suffered any subsidence, landslip or heave? Please give details Are you aware of any survey carried out on your home which mentions subsidence, settlement or movement of the buildings? Please give details Are there any trees or shrubs within 7 metres (22ft) of your home (whether inside or outside your premises) which are more than 3 metres (10ft) tall? Please give details including type of tree, height and distance When, approximately, were the premises to be insured erected? How many bedrooms does the property to be insured have? What is the full cost of reconstruction, £ (the insurable value of the building)?
Minumum value is £40,000
Do you require cover for accidental damage to buildings? (Available for an additional premium)
Are 5 lever mortice deadlocks installed in all external doors, excluding communal doors in the case of flats? Please describe the external door security Are key operated window locks fitted on all patio doors and French windows? Please describe any locks fitted to patio doors and french windows Are key operated window locks fitted on all ground floor basement and accessible windows? Please describe any window security devices Do you have a burglar alarm installed? Who was the installer?
Are they a member of NSI (formerly NACOSS) or Integrity 2000? Is it maintained under contract with the installing company? Please give details What signalling is used? Tick all that apply
Bells
Digital communicator
Red Care
Central station

Do you have a safe installed? What type is it? What is the make and model? Any other protections? Please describe
General Contents of the Home - split as follows:
i. General contents of the house (Excluding gold & silver and gold & silver plated articles, jewellery & furs – Full cost of replacement as new) ii. Total value of Gold & silver articles and gold & silver plated articles (excluding jewellery) Please provide details of any items valued at over £2,000

Description of item 1 Value

£

iii. Total value of any Pictures, Paintings Please provide details of any items valued at over £2,000

Description of item 1 Value

£

Do you require cover for accidental damage to contents? (Available for an additional premium)?
Do you require cover for items away from home? Total value of Personal Possessions Please provide details of any items valued at over £2,000

Description of item 1 Value

£

Value of Computer Equipment Please provide details of any items valued at over £2,000

Description of item 1 Value

£

Value of Jewellery Please provide details of any items valued at over £2,000

Description of item 1 Value

£

Furs Please provide details of any items valued at over £2,000

Description of item 1 Value

£

Mobile Phones Please provide details of any items valued at over £500

Description of item 1 Value

£

Contents of fridges and freezers? (£250 automatically included) How much insurance would you like? Pedal cycles anywhere in the United Kingdom? Number to be insured Total value of all bikes to be insured Please provide details of cycles valued at over £1,000

Description of item 1 Value

£

How much personal money (if any) would you like to insure? (£250 automatically included) Value of credit cards to be insured (if any) (£300 automatically included) What geographical limits for personal possessions cover do you require?
UK* Europe* Worldwide
* This includes elsewhere in the World for up to 60 days in any one period of insurance
Have you or any other person living with you ever been convicted of a criminal offence? What is their relationship to you? Please state relationship How many convictions does this person have?
Date of Conviction 1 Category of conviction Conviction Was a custiodial sentence given?
* Sentence given

Years Months Days

* Sentence served

Years Months Days

What was the sentence?
Please provide any additional information below and details of convictions of anyone else in the household
Name of previous insurers? Date of expiry of policy? Has any insurer declined to accept, cancelled, refused to continue or agreed to continue only on special terms any insurance for the proposer or any other person to whom this Insurance would apply? Please give details Have you or any other person whose property is to be insured sustained any loss or damage during the last six years which would have been covered by this type of insurance had it been in force, whether or not a claim was paid?

Approximate date of loss or damage 1 Amount of loss or damage Details of loss or damage What additional precautions have been undertaken to prevent a recurrence if such loss or damage was by theft?

How many years have you continuously held insurance without making a claim? With whom was the property insured? (if insured) What level of Voluntary Excess would you like? (a £50 compulsory excess applies) Cover Start Date Would you like to include Legal Expenses cover for £11.03 (£10:50 + £0.53 tax)?
Yes No
How Did You Hear About Us Referrer code (if you were referred) Best Price So Far Best Price So Far Who With Best Price So Far What Excess Declaration

I/We declare that to the best of my/our knowledge and belief, the above statements made by me/us or on my/our behalf are true and complete and that I/we have not suppressed, misrepresented or mis-stated any material fact, and that I/we agree to accept the terms and conditions contained in the document of insurance. I/We agree that if any answer has been written by any other person than the undersigned then he/she shall for that purpose be regarded as my/our agent and not of the insurer.
Yes No
Data Protection Act 1998 – Proposer's Consent Clause

I/We hereby consent to any information you may have about me/us being processed by you for the purposes of providing insurance and claims handling, which may necessitate your providing such information to third parties.

N.B. No liability is accepted by the insurers until the proposal is accepted and the premium paid.
I/We hereby consent to any information you may have about me/us being processed by you for the purposes of providing insurance and claims handling, which may necessitate your providing such information to third parties.

N.B. No liability is accepted by the insurers until the proposal is accepted and the premium paid.
Yes No

Description of item 1	Value
	£

Description of item 1	Value
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Description of item 1	Value
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Description of item 1	Value
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