Please note that questions marked with an * are required to be completed in order to provide you with a quote.
Policy Type
Policy Required *
Select
Buildings and Contents
Buildings only
Contents only
About the Policy Holder
Please enter below details relating to the policy holder.
Title *
Select
Mr
Mrs
Miss
Ms
Mx
Dr
Prof
Fr
Sir
Dame
Lord
Lady
Other
First Name *
Last Name *
Email Address *
Telephone Number *
Mobile Number *
Marital Status *
Select
Single
Married
Divorced
Widowed
Civil Partnership
Date of Birth *
Employment Status *
Select
Employed
Self-Employed
Director
Proprietor
Retired
Unemployed
Other
Occupation *
Business Sector / Industry *
Does the policy holder have any criminal convictions? *
Select
Yes
No
Has the policy holder ever been refused insurance? *
Select
Yes
No
Has the policy holder ever had any special terms imposed? *
Select
Yes
No
Does any occupant of the property smoke? *
Select
Yes
No
Does the policy holder have any active CCJs, or ever received a CCJ? *
Select
Yes
No
Has the policy holder been bankrupt, or have any other adverse financial history to declare? *
Select
Yes
No
Is the policy to be a joint policy? *
Select
Yes
No
About the Property
Please enter below details relating to the property to be insured.
First Line of Address *
Second Line of Address
Town / City *
County *
Post Code *
Property Type *
Select
Detached
Detached bungalow
Self-contained flat
Semi-detached
Semi-detached bungalow
Terraced
Townhouse
Other
Property Ownership *
Select
On Mortgage
Outright
Let Unfurnished
Year of Construction (YYYY) *
Is the property a listed building? *
Select
Yes
No
Wall Construction *
Select
Brick
Timber Frame
Prefabricated
Concrete
Other
Roof Construction *
Select
Tile
Slate
Thatched
Concrete
Felt on timber
Felt on concrete
Other
Is the roof maintained and in a good state or repair? *
Select
Yes
No
What percentage of the roof is flat? *
%
What is the construction of the flat roof?
Select
Felt on timber
Felt on concrete
EDPM
Fibreglass on timber
What is the construction of the property floor? *
Select
Concrete
Timber
Both (concrete & timber)
Other
Is the building in a good state of repair? *
Select
Yes
No
Number of Bedrooms *
Number of Bathrooms *
Is the policy holder a first time buyer? *
Select
Yes
No
Does the property house any non-family lodgers? *
Select
Yes
No
Is the property let or sublet? *
Select
Yes
No
Is part of the property used for business? *
Select
No
Yes, clerical only
Yes, clerical including client visitors
Other (Please Specify)
You selected 'Other' for business use. Please specify. *
Is the property used as a holiday home? *
Select
Not a holiday home
Holiday home
Weekend home
Occupancy *
Select
Unoccupied during the day
Unoccupied at night
Occupied day and night
Does the property have smoke detectors fitted on all floors? *
Select
Yes
No
Does the property have 5 lever mortice deadlocks fitted to all external final exit doors? *
Select
Yes
No, 3 bolt multi point locking system
No, hook bolt BS3621
No, other (Please Specify)
You selected 'Other' for deadlocks. Please specify. *
Does the property have key operated window locks? *
Select
Yes
No
Does the property have an intruder alarm installed? *
Select
No
Yes
Are you part of Neighbourhood Watch? *
Select
Yes
No
Are there any tall trees above 5 metres, within 10 metres of the property? *
Select
Yes
No
Are there any ongoing building works being carried out? *
Select
Yes
No
Is the property in a flood free area? *
Select
Yes
No
Is the property free from subsidence, heave, landslip, neighbouring subsidence or past or present subsidence monitoring? *
Select
Yes
No
NCB (No Claims Bonus)
Please enter below details relating to any NCB you have.
How many years NCB do you have on your current buildings insurance?
How many years NCB do you have on your current Contents insurance?
Current insurance renewal date? *
Who is your current insurer?
What is your annual renewal premium?
£
Previous Claims
Please enter below details relating to any claims you have made in the past 5 years.
Have you made any claims within the last 5 years? *
Select
Yes
No
How many claims have you made?
0
1
2
3
4
5
Claim 1
Incident Date
Cover claimed against
Select
Buildings
Contents
Combined
Cause
Select
Loss of jewellery
Malicious damage
Storm damage
Subsidence
Theft
Theft damage
Theft of pedal cycle
Water damage
Fire
Accidental damage
Other
Total amount claimed for
£
Claim 2
Incident Date
Cover claimed against
Select
Buildings
Contents
Combined
Cause
Select
Loss of jewellery
Malicious damage
Storm damage
Subsidence
Theft
Theft damage
Theft of pedal cycle
Water damage
Fire
Accidental damage
Other
Total amount claimed for
£
Claim 3
Incident Date
Cover claimed against
Select
Buildings
Contents
Combined
Cause
Select
Loss of jewellery
Malicious damage
Storm damage
Subsidence
Theft
Theft damage
Theft of pedal cycle
Water damage
Fire
Accidental damage
Other
Total amount claimed for
£
Claim 4
Incident Date
Cover claimed against
Select
Buildings
Contents
Combined
Cause
Select
Loss of jewellery
Malicious damage
Storm damage
Subsidence
Theft
Theft damage
Theft of pedal cycle
Water damage
Fire
Accidental damage
Other
Total amount claimed for
£
Claim 5
Incident Date
Cover claimed against
Select
Buildings
Contents
Combined
Cause
Select
Loss of jewellery
Malicious damage
Storm damage
Subsidence
Theft
Theft damage
Theft of pedal cycle
Water damage
Fire
Accidental damage
Other
Total amount claimed for
£
Additional Information
Please enter below any additional information that may assist us in providing you with your quote.
Additional Information
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