Policy Holder Details

Title:	Mr Mrs Miss Ms Dr *
Surname:	*
First Name:	*
Building name or number:	*
Postcode:	*
Contact No:	*
Email address:	*

Please complete all fields marked with * to proceed.

 Building Details

Cover start date:	*
Proposer's age:	*
Marital status:	No Yes *
Is the insurance  in joint names?	No Yes *
Occupation:	*
Have you had any claims in the past 5 years?	No Yes *
Property Type:	*
How long have you owned the property?	*
What year was the property built?	2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1900 *
How many bedrooms does it have?	1 2 3 4 5 6 7 8 9 10 11 12 *

Please complete all fields marked with * to proceed.

   

 Building Details Continued...

What are the construction of the walls?	*
What construction is the roof?	*

 Has the property got a flat roof?                                                      No Yes *

 

Is the building professionally let?	No Yes *
Is there a tenancy agreement in place between the tenant and landlord? If not, please advise below.	No Yes *

 Does the premises have an alarm installed?                                     No Yes *

Please complete all fields marked with * to proceed.

 

 Cover Required

How much landlords contents cover do you require?	*
How much buildings cover do you require? (the rebuild value of the building)	*

 Contact Information

How would you prefer us to contact you?	Phone Email *
If by phone, what is the best time to call?

Please complete all fields marked with * to proceed.

 Final Step

To proceed and obtain a quote please check the agreement box, then click the "Quote Me Please" button below:

Please tick this box to confirm you authorise us to contact you regarding this quotation.

 What percentage of the overall property does the flat roof represent?