Home Insurance | Providing a personal, dedicated consulting service on a wide variety of insurance policies.

About You

First Name

Last Name

Date of Birth

DD slash MM slash YYYY

Occupation

Employer

Email Address*

Contact Number*

Property Details

Full Address

Street Address Address Line 2 City Postcode Country

Marital Status

Employment Status

Occupation

Type of Industry

Year of Build

Type of Property

Detached

Semi-Detached

Bungalow

Flat

Other

Number of Bedrooms

Construction of Walls

Brick

Stone

Timber

Concrete

Other

Construction of Roof

Slate

Tile

Felt On Timber

Concrete

Other

Any Flat Roof? If Yes Please Give Percentage

Occupancy Details

Is The Property Owner Occupied? If no please give details.

Total Number of Occupants

Total Number of Occupants Under 18 Years of Age

Is the Home Also Used For Business

Buildings Details

What Is The Cost of Rebuilding Your Property?

Do You Require Cover For Accidental Damage?

What Is The Replacement Cost of Your Household Contents

Do You Require Cover For Accidental Damage For Your Contents

Do You Require Cover For Accidental Damage

Any Claims In The Last 5 Years?

Details of Claims Where Applicable Including Dates, Type of Claim, i.e. Theft, & Amount Claimed

Is cover required for contents away from home?

Total Value of Individual items over £2000

List of specified items over £2000

Security

Door Locks – 5 Lever Mortise Lock or 3 Bolt Multi Lock as in PVC Doors.

Key Operated Window Locks?

Do You Have Smoke Detectors?

Do You Have A Burglar Alarm?

Have you ever been cancelled, refused or declined insurance?

Have you ever suffered from subsidence, heave or landslip or are you within 400 metres of a cliff or watercourse?

What Date Would You Like To Go On Cover?

DD slash MM slash YYYY

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