Policyholder Details

Title:	Mr Mrs Miss Ms Dr *
Surname:	*
First Name:	*
House name or number of address to be insured:	*
Postcode of address to be insured:	*
Contact No:	*
Date of Birth:	*
Does anyone at the property smoke?	- No Yes
Policyholder's Full Time Occupation:	*
Employment Status i.e. employed, self employed:	*

Please complete all fields marked with * to proceed

   

Property Details

What type of property is to be insured?      Semi Detached House Semi Detached Town House Semi Detached Cottage Semi Detached Bungalow Semi Detached Masionette Detached House Detached Town House Detached Cottage Detached Bungalow Detached Maisonette End of Terrace House End of Terrace Town House End of Terrace Cottage End of Terrace Bungalow End of Terrace Maisonette Mid Terrace House Mid Terrace Town House Mid Terrace Cottage Mid Terrace Bungalow Mid Terrace Maisonette Basement Converted Flat Ground Floor Converted Flat Basement Purpose Built Flat Ground Floor Purpose Built Flat Other Floor Converted Flat Other Floor Purpose Built Flat Chalet House Boat Link Detached Mobile Home Other *

 

What year did you become resident or own the property?	*
What year was the property built?	*
How many bedrooms does the property have?	1 2 3 4 5 6 7 8 9+ *
What type of construction are the walls?	Brick Brick/Timber Timber Concrete Cob Corrugated Iron Stone Fibreglass Flint Essex Construction Metal Asbestos Pre-fab Combustible Pre-fab Non-Combustible *
What type of construction is the roof?	Tile Ashpalt Concrete Slate Glass Shingle Thatch - Fibre Thatch - Reed Corrugated Iron Fibreglass Metal Plastic *
What is the type of ownership of the property?	Mortgaged - Not Let Housing Association - Furnished Housing Association - Unfurnished Local Authority - Furnished Local Authority - Unfurnished Mortgaged - Let Furnished Mortgaged - Let Unfurnished Mortgaged - Sharing Owned - Not Let Owned - Let Furnished Owned - Let Unfurnished Owned - Sharing Private Landlord - Furnished Private Landlord - Unfurnished Tied Occupancy - Furnished Tied Occupancy - Unfurnished *
What is the occupancy status of the home?	Permanent Home Holiday Home Let - Benefits Assisted Let - Professional Persons Let - Students Unoccupied - to be owner occupied within 30 days Unoccupied - to be owner occupied within 60 days Unoccupied - to be owner occupied within 90 days Unoccupied - to be owner occupied within 180 days Unoccupied - to be owner occupied within 1 year# Unoccupied - to be sold within 30 days Unoccupied - to be sold within 60 days Unoccupied - to be sold within 90 days Unoccupied - to be sold within 180 days Unoccupied - to be sold within 1 year *

Please complete all fields marked with * to proceed

   

Contents Cover (Accidental damage is automatically included)

Do you require cover for your contents?

     

Contents Cover Details

Please enter the total amount of contents you wish to insure inside the home. This figure should exclude items valued individually at over £1,000 that you wish to also specifically insure whilst outside the home, such as video camera, pedal cycle, Rolex watch etc:	£ *
Of the total amount of contents insured in the home, how much is represented by valuables in the home i.e. gold, silver, other previous metals?	£ *
How many years have you been insured claim free on contents insurance cover?	0 1 2 3 4 5 6 7+ *

Please complete all fields marked with * to proceed

     

Contents Cover Outside the Home (Specified Items)

Do you require cover for any contents outside the home including pedal cycles, laptops, personal effects or specific items individually worth over £1,000 outside the home?    No Yes *

 

Collective Personal Effects/Valuables Outside the Home

Do you require cover for any personal effects, sports equipment (excluding pedal cycles), valuables, or photo/video equipment outside the home?         No Yes *

 

Do you require cover for family legal protection? No Yes *

 

Please complete all fields marked with * to proceed

Specified Items  (Items individually valued at over £1,000 and pedal cycles at any value)

Do you require cover for any pedal cycles outside the home?   No Yes *

 

 

Do you require cover for specified items outside the house which are individually worth over £1,000? No Yes *

 

 

 

Please complete all fields marked with * to proceed

 

Please enter the sum of each pedal cycle to be insured:

£ £ £ £

Please advise the type of item you wish to add i.e. ring, watch, guitar etc:

What is the value of this item? £

Do you wish to add further items?

          Please enter the total overall sum to be insured:    £

  Please enter the sum to be insured:    £

  Please enter the sum to be insured:    £