Name:

Telephone:

Email:

Address:

Postcode:

Date Of Birth:

Domestic Partner's:

Occupation:

Domestic Partner's:

Previous Insurers/Policy Number If Known:

Renewal Date:

Approx Year Property Built

Property Type

Number of Bedrooms

Buildings Sum Insured:

Contents:

Cover Required ie New/Old Accidental Damage:

Is The Home Your Permanent Residence ie Not Let:

Is The Home Constructed Of Brick, Stone, Or Concrete And Roofed With Slates, Tiles, Asphalt, Concrete Or Metal?

Does The Home Have Any Sign Of Damage, Or Are You Aware Of Any Previous Damage, By Subsidence, Heave Or Landslip?

Have You Made Any Claims Under Any Buildings/Content Policy?

Maximum value for any one item and What it is?

Cover for items required outside the house?

If so, Sums insured / Details of items?

Number of years claim free?

Is property mortgaged or owned outright?

Is the property let or owner occupied?

Is the property a listed building, if so what listing?

Any flat roof or extension?

Any business use?

Any nearby trees or watercourses?

Good state of repair?

Maintained Alarm installed 5 lever mortice locks Key operated window locks Smoke alarms
Safe Neighbourhood watch Exterior lighting