Home Insurance Quotation Form

Home Insurance Quotation Form

Please complete the form below with as much information as possible.

We apologise for the number of questions. Please bear with us. The answers to the questions will enable us to obtain the maximum amount of discount to the premium.

Once we receive the information we will input it into our quotation system to obtain the best possible quotation using our substantial panel of top UK insurers.

We will then E-Mail the quotation to you as soon as possible.

Privacy Statement

We would advise you that the information provided will only be used for the purposes of providing you with the relevant quotation and none of the information will be passed on to a third party or any other organisation without your prior permission.

1. About You.

Title	Mr Mrs Miss Ms	Tel No(Incl STD Code)
First Name(s)		Fax No(Incl STD Code)
Surname		E-Mail Address
Address		Date of Birth
Town/Village		Occupation
City		Home Owner?	Yes No
County		Married?	Yes No
Post Code

2. Your Property.

Year property built	Type of property
Walls	Roof
Owner	Unoccupied?
Business use?	History of subsidence?	No Yes
Number of bedrooms	History of flooding?	No Yes

3. Security Protections.

Please give details below of types of locks on doors and windows:

Do you have a burglar alarm? No Yes

If YES was it fitted by a NACOSS approved alarm company? No Yes

Do you have a maintenance agreement on the alarm? No Yes

Are you a member of Neighbourhood Watch? No Yes

Do you have a smoke alarm? Yes No

4. Cover Required.

Buildings only Contents only Buildings and contents

Buildings.

Do you require accidental damage cover(in addition to standard cover)? Yes No

What sum insured is required? £

Contents.

Do you require accidental damage cover(in addition to standard cover)? Yes No

What sum insured do you require? £

Do you want to cover personal possessions(incl valuables) away from home? Yes No

If YES give details of sums insured required below:

i)Unspecified personal possessions(incl valuables) up to £1000 any one item. £

ii)Specified items over £1000 any one item(List items below):

Description	Sum Insured £
1.
2.
3.
4.
5.

iii)Pedal cycles(Give details below)

Make and Model	Sum Insured £
1.
2.
3.
4.

5. Previous Insurance and Loss History.

Have you or any or any member of your household made a claim in the last 5 years? No Yes

If YES give details below:

Date of Loss	Description of claim	Amount of claim £

Have you been previously insured? Yes No If YES give details below:

	Name of Insurer	Date of Expiry
Buildings
Contents