Proposers Details
Owner(s) Of The Property
Proposers Name(s)(incl. all partners' names if partnership) :
Limited Company Name:(only if a Ltd. company owns the buildings)
Ownership Status:
- Please Select -
Sole Owner
Partnership
Ltd. Company
Association
Charity
Club
Proposer's Correspondence Address:
Postcode:
Daytime Telephone No.
E-Mail Address:
Proposers History
Has any insurer ever refused, declined, cancelled or imposed special terms? Yes No
If yes, please provide details:
Have you, or any other partner or director ever been convicted of or charged with any criminal offence? Yes No
If yes, please provide details:(i.e. type of conviction(s), date of conviction(s), length of custodial sentence or details of any fines imposed, etc.)
Have you, or any other partner or director ever had any county court judgements or ever been declared bankrupt or insolvent? Yes No
If yes, please provide details:(i.e. date of bankruptcy/insolvency, amount of bankruptcy/insolvency, date of discharge, etc.)
No. of years operating as a property owner?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
30+ years
Cover Required
Level of cover required:
- - - - - - - - - - - - - - Please Select - - - - - - - - - - - - - -
Standard Perils Cover (fire, theft, flood, storm, etc.)
All Risks Cover (std. perils + accidental damage)
Is cover required for subsidence? Yes No
Is cover required for terrorism? Yes No
Property owners liability limit of indemnity:
Not Required
£1 Million
£2 Million
£5 Million
Property 1.
Risk Address 1.
Address of property to be insured:
Postcode of property to be insured:
Risk Details
Occupation/Business of Main Tenant(s):(please state if unoccupied)
Approximately, what year was the property built?
Is the property a listed building? (e.g. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Occupancy Details
Please state the tenancy of the occupant:
- - - - - - - Please Select - - - - - - -
Asylum Seekers
Commercial Let
DSS Tenants
Professional Working Tenants
Student Tenants
Unoccupied
Are any of the areas of the building unoccupied? Yes No
If yes, please provide details:
Construction
Property details:
- Please Select -
Commercial
Residential
Industrial
Other
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, flat, etc.) :
Percentage Flat Roofing (if applicable) : %
If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') :
Construction of Floors (e.g. concrete, wood, etc.) :
Buildings
Buildings Sum Insured (£s):
Loss of Rent
If cover is required for loss of rent, please state the current rent receivable (£s): (£'s per annum)
Landlords Contents
Landlords Contents (if required) (£s):
Additional Properties
Do you wish to add another property? Yes No
Property 2.
Risk Address 2.
Address of property to be insured:
Postcode of property to be insured:
Risk Details
Occupation/Business of Main Tenant(s):(please state if unoccupied)
Approximately, what year was the property built?
Is the property a listed building? (e.g. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Occupancy Details
Please state the tenancy of the occupant:
- - - - - - - Please Select - - - - - - -
Asylum Seekers
Commercial Let
DSS Tenants
Professional Working Tenants
Student Tenants
Unoccupied
Are any of the areas of the building unoccupied? Yes No
If yes, please provide details:
Construction
Property details:
- Please Select -
Commercial
Residential
Industrial
Other
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, flat, etc.) :
Percentage Flat Roofing (if applicable) : %
If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') :
Construction of Floors (e.g. concrete, wood, etc.) :
Buildings
Buildings Sum Insured (£s):
Loss of Rent
If cover is required for loss of rent, please state the current rent receivable (£s): (£'s per annum)
Landlords Contents
Landlords Contents (if required) (£s):
Additional Properties
Do you wish to add another property? Yes No
Property 3.
Risk Address 3.
Address of property to be insured:
Postcode of property to be insured:
Risk Details
Occupation/Business of Main Tenant(s):(please state if unoccupied)
Approximately, what year was the property built?
Is the property a listed building? (e.g. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Occupancy Details
Please state the tenancy of the occupant:
- - - - - - - Please Select - - - - - - -
Asylum Seekers
Commercial Let
DSS Tenants
Professional Working Tenants
Student Tenants
Unoccupied
Are any of the areas of the building unoccupied? Yes No
If yes, please provide details:
Construction
Property details:
- Please Select -
Commercial
Residential
Industrial
Other
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, flat, etc.) :
Percentage Flat Roofing (if applicable) : %
If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') :
Construction of Floors (e.g. concrete, wood, etc.) :
Buildings
Buildings Sum Insured (£s):
Loss of Rent
If cover is required for loss of rent, please state the current rent receivable (£s): (£'s per annum)
Landlords Contents
Landlords Contents (if required) (£s):
Additional Properties
Do you wish to add another property? Yes No
Property 4.
Risk Address 4.
Address of property to be insured:
Postcode of property to be insured:
Risk Details
Occupation/Business of Main Tenant(s):(please state if unoccupied)
Approximately, what year was the property built?
Is the property a listed building? (e.g. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Occupancy Details
Please state the tenancy of the occupant:
- - - - - - - Please Select - - - - - - -
Asylum Seekers
Commercial Let
DSS Tenants
Professional Working Tenants
Student Tenants
Unoccupied
Are any of the areas of the building unoccupied? Yes No
If yes, please provide details:
Construction
Property details:
- Please Select -
Commercial
Residential
Industrial
Other
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, flat, etc.) :
Percentage Flat Roofing (if applicable) : %
If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') :
Construction of Floors (e.g. concrete, wood, etc.) :
Buildings
Buildings Sum Insured (£s):
Loss of Rent
If cover is required for loss of rent, please state the current rent receivable (£s): (£'s per annum)
Landlords Contents
Landlords Contents (if required) (£s):
Additional Properties
Do you wish to add another property? Yes No
Property 5.
Risk Address 5.
Address of property to be insured:
Postcode of property to be insured:
Risk Details
Occupation/Business of Main Tenant(s):(please state if unoccupied)
Approximately, what year was the property built?
Is the property a listed building? (e.g. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Occupancy Details
Please state the tenancy of the occupant:
- - - - - - - Please Select - - - - - - -
Asylum Seekers
Commercial Let
DSS Tenants
Professional Working Tenants
Student Tenants
Unoccupied
Are any of the areas of the building unoccupied? Yes No
If yes, please provide details:
Construction
Property details:
- Please Select -
Commercial
Residential
Industrial
Other
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, flat, etc.) :
Percentage Flat Roofing (if applicable) : %
If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') :
Construction of Floors (e.g. concrete, wood, etc.) :
Buildings
Buildings Sum Insured (£s):
Loss of Rent
If cover is required for loss of rent, please state the current rent receivable (£s): (£'s per annum)
Landlords Contents
Landlords Contents (if required) (£s):
Additional Properties
Do you wish to add another property? Yes No
Property 6.
Risk Address 6.
Address of property to be insured:
Postcode of property to be insured:
Risk Details
Occupation/Business of Main Tenant(s):(please state if unoccupied)
Approximately, what year was the property built?
Is the property a listed building? (e.g. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Occupancy Details
Please state the tenancy of the occupant:
- - - - - - - Please Select - - - - - - -
Asylum Seekers
Commercial Let
DSS Tenants
Professional Working Tenants
Student Tenants
Unoccupied
Are any of the areas of the building unoccupied? Yes No
If yes, please provide details:
Construction
Property details:
- Please Select -
Commercial
Residential
Industrial
Other
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, flat, etc.) :
Percentage Flat Roofing (if applicable) : %
If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') :
Construction of Floors (e.g. concrete, wood, etc.) :
Buildings
Buildings Sum Insured (£s):
Loss of Rent
If cover is required for loss of rent, please state the current rent receivable (£s): (£'s per annum)
Landlords Contents
Landlords Contents (if required) (£s):
Additional Properties
Do you wish to add another property? Yes No
Property 7.
Risk Address 7.
Address of property to be insured:
Postcode of property to be insured:
Risk Details
Occupation/Business of Main Tenant(s):(please state if unoccupied)
Approximately, what year was the property built?
Is the property a listed building? (e.g. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Occupancy Details
Please state the tenancy of the occupant:
- - - - - - - Please Select - - - - - - -
Asylum Seekers
Commercial Let
DSS Tenants
Professional Working Tenants
Student Tenants
Unoccupied
Are any of the areas of the building unoccupied? Yes No
If yes, please provide details:
Construction
Property details:
- Please Select -
Commercial
Residential
Industrial
Other
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, flat, etc.) :
Percentage Flat Roofing (if applicable) : %
If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') :
Construction of Floors (e.g. concrete, wood, etc.) :
Buildings
Buildings Sum Insured (£s):
Loss of Rent
If cover is required for loss of rent, please state the current rent receivable (£s): (£'s per annum)
Landlords Contents
Landlords Contents (if required) (£s):
Additional Properties
Do you wish to add another property? Yes No
Property 8.
Risk Address 8.
Address of property to be insured:
Postcode of property to be insured:
Risk Details
Occupation/Business of Main Tenant(s):(please state if unoccupied)
Approximately, what year was the property built?
Is the property a listed building? (e.g. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Occupancy Details
Please state the tenancy of the occupant:
- - - - - - - Please Select - - - - - - -
Asylum Seekers
Commercial Let
DSS Tenants
Professional Working Tenants
Student Tenants
Unoccupied
Are any of the areas of the building unoccupied? Yes No
If yes, please provide details:
Construction
Property details:
- Please Select -
Commercial
Residential
Industrial
Other
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, flat, etc.) :
Percentage Flat Roofing (if applicable) : %
If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') :
Construction of Floors (e.g. concrete, wood, etc.) :
Buildings
Buildings Sum Insured (£s):
Loss of Rent
If cover is required for loss of rent, please state the current rent receivable (£s): (£'s per annum)
Landlords Contents
Landlords Contents (if required) (£s):
Additional Properties
Do you wish to add another property? Yes No
Property 9.
Risk Address 9.
Address of property to be insured:
Postcode of property to be insured:
Risk Details
Occupation/Business of Main Tenant(s):(please state if unoccupied)
Approximately, what year was the property built?
Is the property a listed building? (e.g. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Occupancy Details
Please state the tenancy of the occupant:
- - - - - - - Please Select - - - - - - -
Asylum Seekers
Commercial Let
DSS Tenants
Professional Working Tenants
Student Tenants
Unoccupied
Are any of the areas of the building unoccupied? Yes No
If yes, please provide details:
Construction
Property details:
- Please Select -
Commercial
Residential
Industrial
Other
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, flat, etc.) :
Percentage Flat Roofing (if applicable) : %
If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') :
Construction of Floors (e.g. concrete, wood, etc.) :
Buildings
Buildings Sum Insured (£s):
Loss of Rent
If cover is required for loss of rent, please state the current rent receivable (£s): (£'s per annum)
Landlords Contents
Landlords Contents (if required) (£s):
Additional Properties
Do you wish to add another property? Yes No
Property 10.
Risk Address 10.
Address of property to be insured:
Postcode of property to be insured:
Risk Details
Occupation/Business of Main Tenant(s):(please state if unoccupied)
Approximately, what year was the property built?
Is the property a listed building? (e.g. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Occupancy Details
Please state the tenancy of the occupant:
- - - - - - - Please Select - - - - - - -
Asylum Seekers
Commercial Let
DSS Tenants
Professional Working Tenants
Student Tenants
Unoccupied
Are any of the areas of the building unoccupied? Yes No
If yes, please provide details:
Construction
Property details:
- Please Select -
Commercial
Residential
Industrial
Other
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, flat, etc.) :
Percentage Flat Roofing (if applicable) : %
If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') :
Construction of Floors (e.g. concrete, wood, etc.) :
Buildings
Buildings Sum Insured (£s):
Loss of Rent
If cover is required for loss of rent, please state the current rent receivable (£s): (£'s per annum)
Landlords Contents
Landlords Contents (if required) (£s):
Claims Experience
Claims Experience
Have you suffered any loss or had any claims made against any of the above properties in the last 5 years? Yes No
Please provide details of all claims:(i.e. address of property, date of claim, amount claimed, circumstances of the claim, etc.)
Additional Information / Covers
If there is any other information you wish to disclose or if you have any additional cover requirements, please provide details:
Details Of Current / Previous Policies
Current annual premium: This may help us to get you a better quote
Current insurer:
Renewal date/date cover required: (dd/mm/yyyy)