Tel: 01623 641 386

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Home Insurance Quote Form

For UK Customers Only

Please insert your details here and we will provide you with a competitive home insurance quote 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 01623 641 386 for assistance.

Proposers Details

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

Do you wish to add a second proposer?	Yes No
2nd Proposers Details
Status:
First Name:
Surname:
Relationship to Proposer:
Date of Birth:	(dd/mm/yyyy)
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?	Yes No
If yes, please provide details:
Level of security: (Tick whichever are applicable)	NACOSS/NSI 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 grade listed (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?	Yes No
If yes, please provide details:	Date of claim 1: Cost of claim:£ Type of claim: ----- Date of claim 2: Cost of claim:£ Type of claim: ----- Date of claim 3: Cost of claim:£ Type of claim: ----- Unfortunately, we are unable to provide a quotation if you have exceeded 3 claims. -----
Have you had any claims in the last 5 years?	Yes No
If yes, please provide details:	Date of claim 1: Cost of claim:£ Type of claim: ----- Date of claim 2: Cost of claim:£ Type of claim: ----- Date of claim 3: Cost of claim:£ Type of claim: ----- Unfortunately, we are unable to provide a quotation if you have exceeded 3 claims. -----

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 personal possessions away from your home? (e.g. clothing, jewellery, etc.)	Yes No Help?
Please state the sum insured for personal possessions away from the home: (Standard cover provides £2,000 sum insured)
Would you also like to include cover for pedal cycles away from the home?	Yes No Number of pedal cycles:
Would you like to add a burglar alarm onto your policy?	Yes No (Click here for alarm details)

Specified Item(s)

Individual valuables or jewellery are usually restricted to £1,500 per item unless specified.
Do you wish to specify any valuables or jewellery?	Yes No
Please provide details of any special items / valuables over £1,500 that you wish to specify on your policy:

Item	Description (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.