HOME APPLICATION

Personal Details

Name(s) of Policy Holder(s)
Policy Holder 1
Policy Holder 2
Date(s) of Birth
Policy Holder 1
Policy Holder 2
Occupation(s)
Policy Holder 1
Policy Holder 2
Email Address
Contact Telephone No's
Policy Holder 1
Policy Holder 2
RENEWAL OR PREFERRED QUOTATION DATE*


* To give you plenty of time we will contact you 3-4 weeks before this date.

Property Details

Risk Address & Post Code
Type of Property
Style
Position
Cost to rebuild*


* (If in doubt, the market value may give an approximate idea.
Although often higher than needed as it includes the value of the land)

Construction
Walls
Roof
Does the property have area(s) of flat roof
If YES, what % of the total roof is flat?
Year Built
Is the property a listed building?
Number of Bedrooms
Number of bathrooms/shower rooms/ensuites?
Has there been a history of, or are there any signs of subsidence/landslip/heave?
Is the property in an area which has suffered flooding (within 400m)?

Contents

What is the total replacement value of your contents as new?
To cover personal belongings taken away from home, what is the maximum amount taken out by you and your household at any one time?

Claims

Approximately how long have you been claims free?
Buildings
Contents
Is there any other information you would like to give us?