Household Buildings / Contents Quotation Form

Please complete the enquiry form below to receive an insurance quotation for your Household Insurance. We will contact you, with your quotation, by e-mail, telephone, fax or post. Please select your preference on the form. When you have completed the form, press the 'Submit Details' button to proceed.

Please try to complete all details as omissions may affect the given quote.

We aim to provide a fast response to your enquiry and will endeavour to acknowledge receipt of your enquiry the same day.

Before completing the form please read the Terms of Business. If you have any queries please contact us.

Proposer Details: Title Please Select... Mr Mrs Miss Ms Dr Prof Forename(s) Surname Address Post Code Daytime Telephone Number Evening Telephone Number Fax Number E-mail Address Renewal Date Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2003 2004 2005 2006 2007 2008 2009 2010 Best Quote to Date Current Insurer Please state how long you have resided at this Address Please state your Date of Birth Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year: Please state your Occupation Type of Industry worked in Are you a first time buyer? Please Select... Yes No Does anyone in your household smoke? Please Select... Yes No Property Details: Type of Property Please Select... Detached House Semi-Detached House Detached Bungalow Semi Detached Bungalow Mid Terrace House End Terrace House Purpose Built Flat Other, please state When was your property built? Number of bedrooms Please Select... 1 2 3 4 5 6 or more Is Buildings Cover required? Please Select... Yes, with Accidental Damage Yes, without Accidental Damage Not Required Please state Buildings Sum Insured Voluntary Buildings Excess required? Please Select... £0 £100 £200 £300 £400 £500 Please state number of claim free years you have had on Buildings Insurance Please Select... No previous insurance 1 year claim free 2 years claim free 3 years claim free 4 years claim free 5 or more years claim free Is Contents Cover required? Please Select... New for Old with Accidental Damage New for Old without Accidental Damage Not Required Total Contents Sum Insured Total Valuables Sum Insured Please state number of claim free years you have had on Contents Insurance Please Select... No previous insurance 1 year claim free 2 years claim free 3 years claim free 4 years claim free 5 or more years claim free Does your contents sum insured represent the full replacement value? Please Select... Yes No Construction of roof Please Select... Asbestos Concrete Corrugated Iron Felt on Timber Metal Shingle Slate Thatch Tiled Timber Construction of walls Please Select... Asbestos Brick Brick/Timber Frame Cob Concrete Corrugated Iron Metal Stramit Timber Timber Plaster Timber Frame What percentage of your roof is flat? Please Select None 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Is your home and the surrounding area free from any signs of landslip, subsidence or heave? *if no then we will need to contact you Please Select... Yes No Is your home free from any previous underpinning or any remedial action due to subsidence, landslip or heave? *if no then we will need to contact you Please Select... Yes No Is your home in an area free from flooding? *if no then we will need to contact you Please Select... Yes No Is your home within 250 metres of a cliff, river bank, lake, seafront, reservoir, quarry or other excavation? *if yes then we will need to contact you Please Select... Yes No Are there any trees or shrubs within 7 metres of the property that are more than 5 metres tall? *if yes then we will need to contact you Please Select... Yes No Do you require cover for items taken outside of the home? (Personal Possessions/All Risks) Please respond to all 8 items listed below: 1/8) Photographic Equipment? Please Select... Not Required £100 £200 £300 £400 £500 £600 £700 £800 £900 £1000 2/8) Sports Equipment? Please Select... Not Required £100 £200 £300 £400 £500 £600 £700 £800 £900 £1000 3/8) Valuables Please Select... Not Required £100 £200 £300 £400 £500 £600 £700 £800 £900 £1000 4/8) Personal Effects? Please Select... Not Required £100 £200 £300 £400 £500 £600 £700 £800 £900 £1000 5/8) Pedal Cycles? Please Select... Not Required £100 £200 £300 £400 £500 £600 £700 £800 £900 £1000 6/8) Frozen Foods? Please Select... Not Required £100 £200 £300 £400 £500 £600 £700 £800 £900 £1000 7/8) Money? Please Select... Not Required £100 £200 £300 £400 £500 £600 £700 £800 £900 £1000 8/8) Credit Cards? Please Select... Not Required £100 £200 £300 £400 £500 £600 £700 £800 £900 £1000 Security: Does you property have BS3621 locks on all external doors? Please Select... Yes No Does your property have key operated locks fitted to all accessible windows and patios? Please Select... Yes No Does your property have an alarm? Please Select... None Yes, D.I.Y. Installation Yes, NACOSS/SSAIB Bells only with maintenance Yes, NACOSS/SSAIB Bells only WITHOUT maintenance Yes, NACOSS/SSAIB Central Station with maintenance Yes, NACOSS/SSAIB Central Station WITHOUT maintenance Yes, NACOSS/SSAIB Red Care with maintenance Yes, NACOSS/SSAIB Red Care WITHOUT maintenance Yes, but not sure of system Are you a member of an approved Neighbourhood Watch scheme? Please Select... Yes No Is your property fitted with a BSI approved smoke detector? Please Select... Yes No Underwriting Questions (Must be answered): Type of Ownership Please Select... Owned on a mortgage Owned outright Rented from Local Authority Rented from Private Landlord Is the property a listed building? Please Select... No Grade 1 Listed Grade 2 Listed Preservation Order Have you or anyone living with you ever been convicted or arson, theft or any offence other than driving offences? (Convictions regarded as spent by virtue of the Rehabilitation of Offenders Act 1974 need not be disclosed) *if yes then we will need to contact you Please Select... Yes No Have you or anyone usually living with you ever had any financial or legal problems such as Bankruptcy, Liquidation or CCJs? *if yes then we will need to contact you Please Select... Yes No Have you or anyone living with you had any previous insurance subjected to increased terms, conditions, withdrawn or refused? *if yes then we will need to contact you Please Select... Yes No General: Preferred Method Of Contact Please Select... Telephone Fax Email Post Any Enquiry Source Please Select... Yellow Pages Thomson Local The Sun Google Seek.net Van Finder Yell.com Find Search Engine Recommendation Other

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