Personal Household Application
    (Owner occupied)

    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)?
    If you have a mortgage on your property,
    please advise the name of the mortgage company

    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?