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Policy Holder 1
Policy Holder 2
Email Address
Renewal or Preferred Quotation Date: To give you plenty of time we will contact you 3-4 weeks before this date
Risk Address & Post Code:
Style Please select from the list Bungalow Chalet Bungalow Flat House Other
Position Please select from the list Detached Link Detached Semi-Detached Terraced Other
If you answered ‘other’ for either question, please give details here:
Is the building owner occupied? Please select from the list Yes No
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)
Walls Please select from the list Brick Cob Stone Timber Other
Roof Please select from the list Slate Tile Thatch Other
Does the property have area(s) of flat roof? Please select from the list Yes No
If YES, what percentage of the total roof is flat?
Year Built:
Is the property a listed building? Please select from the list Yes No
Number of Bedrooms:
Number of bathrooms/shower rooms/ensuites:
Has there been a history of, or are there any signs of subsidence/landslip/heave? Please select from the list Yes No
Is the property in an area which has suffered flooding (within 400m)? Please select from the list Yes No
If you have a mortgage on your property, please advise the name of the mortgage company
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?
Buildings
Contents
Is there any other information you would like to give us?
