For UK Customers Only

Please insert your details here and we will provide you with a competitive home insurance quotation shortly from our wide range of insurers.

This quotation form is designed for proposers wishing to insure their buildings and/or contents for their main residence only and not for properties let to tenants. Please also refer to us if the property is unoccupied or any business activities are carried out from the home.

If you have any problems completing this form, please phone us on 08453 455 855 for assistance.

Proposers Details

1st Proposers Details
Status:
First Name:
Surname:
Marital Status:
Address of property
to be insured:
Postcode:
Postal address:
(if different from above)
Date of Birth:
Occupation:
Employers Business:
Employment Status:
Daytime Telephone No.:
E-Mail Address:

2nd Proposers Details (if applicable)
Status:
First Name:
Surname:
Relationship to Proposer:
Date of Birth:
Occupation:
Employers Business:
Employment Status:

General Information

Type of house:
Number of storeys:
Occupancy:
Property ownership:
Is the property ever
unoccupied for more than 30 days?
Level of security:
(Tick whichever are applicable)		 NACOSS alarm fitted
Smoke Detectors
Member of Neighbourhood Watch
5 Lever Mortice Locks for Exterior
      Doors and Window Locks
Do you currently hold home insurance?
If yes, please indicate how many
years you have held home insurance:
No. of bedrooms:
Are you or any other persons smokers?
Approximate year
the property was built:
Is the property a grade listed building?
(e.g. grade I, II, etc.)
Property Construction
Construction of Walls
Construction of Roof
Percentage flat roofing (if applicable):%
Claims History/Experience
Have you had any subsidence or
flooding damage on the property?
If yes, please provide details:
Have you had any
claims in the last 5 years?
If yes, please provide details:

Buildings Insurance Details (for home owners only)

Buildings Sum Insured (£'s) (Standard Perils Cover)  Help?
Accidental Damage Cover: (Click box if accidental damage cover is required)

Contents Insurance Details

Contents Sum Insured (£'s) (New for Old Cover)  Help?
Accidental Damage Cover: (Click box if accidental damage cover is required)

Extra Cover (optional)
 
Is cover required
for your possessions
away from your home?
(e.g. clothing, jewellery, etc.)		  Help?
If yes, would you also like
to include cover for pedal
cycles away from the home?		Yes    No       Number of cycles:
Would you like to add a
burglar alarm onto your policy? 		Yes    No  (Click here for alarm details)

Specified Item(s)
 
NB. Individual valuables/jewellery are usually restricted to £1,500 per item unless specified.
If you have any special items / valuables over £1,500 that you wish to specify on your policy, please provide details below:
ItemDescription (e.g. 18ct Gold ring)Value (£'s)
1.
2.
3.
4.
5.
 
Renewal/Cover Start Date

Home Insurance Renewal / Cover Start Date:  (dd/mm/yyyy)

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct and that you have answered all the questions accurately then press the Request Home Insurance Quotation button and we will contact you shortly with a quotation.