Please confirm name of the policyholder:
Please confirm date of birth:
Please confirm occupation:
Do you require an additional policyholder:
Please confirm name of the additional policyholder:
Please confirm date of birth of additional policyholder:
Please confirm occupation of additional policyholder:
How did you hear about us:
Contact telephone number:
Contact email address:
Preferred start date:
Have you had any previous CCJ’s, Bankruptcies, or were you the director of a liquidated company personally or in a company name (this applies to all directors if in a company name):
Please supply further details:
Have you had any insurance declined, terminated, refused or special terms imposed:
Please supply further details:
Do you have any criminal convictions other than motoring:
Please supply further details:
Have there been any household claims or losses in the last 5 years:
Please list claim details:- Date, Details of the Loss, Cost of Repair, Is the claim now settled
How many years have you consecutively held household insurance with no claims:
Please confirm your current insurer (if known):
What is your current renewal (if applicable):
Address of the property:
Postcode of the property:
Approximate date of purchase:
Number of adults residing:
Number of children below 18 residing:
Type of property:
House Terraced
House Semi-Detached
House Detached
Individual Flat
Other
Please provide further details:
How many bedrooms:
How many bathrooms:
Is the property standard construction i.e. walls of brick, stone or concrete & roofed with tile, slate or concrete:
Please provide further details:
What % of the overall area is the flat roof:
What is the material of the flat roof:
Do you know when the flat roof was last inspected by a professional contractor:
Approximate year of build:
Is the property grade listed:
Grade:
Conservation Area
Grade 2*
Grade 2
Grade 1
Grade A (Scotland)
Grade B (Scotland)
Grade C (Scotland)
Are there key operated window locks and do the doors have 5 lever mortice deadlocks:
Please describe locks on the windows and final exit doors:
Are there any Patio or French Double Doors:
Please confirm locking system:
Is there an intruder alarm with a maintenance agreement in force:
Please confirm alarm installer and type of alarm:
Is there a safe installed:
Please confirm type and cash value:
Are you part of a neighbourhood watch scheme:
Has the property ever suffered from cracking, movement, subsidence or been underpinned:
Please provide further details including cause, approx date of incident, costs involved with repair:
Has the property ever been flooded:
Please provide further details including approx date of incident, costs involved with repair and any improvement measures implemented:
Are there any trees or shrubs within 7m of the home, whether inside or outside of the boundary of your property, which are more than 3m tall:
Please provide type of trees/shrubs, height and distance to property:
Is your home unoccupied for more than 30 consecutive days:
Please confirm maximum amount of consecutive days:
Do you have lodgers at your property:
Please confirm number of lodgers:
Do you let your property or any part of via Airbnb/holiday let:
Please confirm if this area is self contained and how many days approx per year:
Will there be any business use:
Is this clerical work only with no staff/customers entering premises:
Please provide details of business operating from home:
Is the property to undergo any renovation plans:
Please provide a description of the works planned:
Has planning permission been approved:
Please provide further details:
Please confirm approximate cost of works:
Please provide a split between structural & non-structural works:
Structural:
Non-structural:
Are works being undertaken by a professional contractor:
Does the professional contractor have the relevant insurances in place:
Are the works being carried out under a JCT contract:
Please confirm JCT used:
Approximate start date of works:
Approximate duration of works (in months):
Is there any demolition work:
Please confirm further details:
Are there any basement works:
Please confirm further details:
Will you reside at the premises during the works:
Re-build Value: This will be provided on a blanket sum insured (unless stated otherwise in the quote) up to a minimum of £750,000k.
Does your re-build value exceed this limit:
Re-build declared value (Not Market Value):
This is the cost to re-build your property to the same condition after a total loss. It needs to include removal of debris costs, professional fees, labour and the cost of materials involved with the re-build process. Its so important to obtain the correct value as underinsurance can lead to reduced claims of any size.
If you don’t know your re-build value, you can use our website for residential standard property (this is a guide only). Alternatively, please contact us for a discounted professional RICS re-instatement value.
Please confirm the total amount of contents to be covered:
Within this limit, please confirm the separate total amount for each of the below within the home only:
Jewellery & Watches:
Items of Gold, Silver or Other Precious Metals:
Hearing Aids:
Fine Art:
Furs & Antiques:
Guns:
Collections:
Stamps:
Wine & Spirits:
Musical Instruments:
Please list any items with an individual value over £2,000:
Would you like to increase your standard excess:
Please confirm the maximum standard excess you would like:
Away from Home/Personal Possessions
Please confirm the total amount of contents to be covered away from the home:
Please list any items with an individual value over £2,000:
Do you require any Pedal Cycle cover away from home:
Please confirm total amount of cover:
Please specify any pedal cycles over £500:
Family Legal Expenses
Legal Costs & Expenses cover for a wide range of issues a family might incur in certain legal disputes
Do you require this cover:
Home Emergency
This is designed to provide immediate assistance in the event of unexpected and emergency issues within your home. This covers up to a set amount per incident and includes events such as boiler breakdown, plumbing issues, security issues, lost keys, electrical issues etc
Do you require this cover:
You have a duty under the Insurance Act 2015 to make a fair presentation of the risk to insurers. This duty applies when You take out Your insurance cover, throughout the life of Your policy, and when You renew Your insurance.
The Act includes a need for You to undertake a reasonable search for material information which is known, or ought reasonably to be known, by Your company’s principals, directors, senior management (ie. anyone playing a significant role in making business decisions in Your firm) and staff responsible for insurance. If you do not fully understand the personal situation of your partners / directors / senior management staff with regards to CCJs, bankruptcies, convictions etc then it is your responsibility to find this information out.
You should advise Us of any particular concerns which led You to seek insurance cover and any special or unusual facts relating to the risk.
You must ensure that all material statements of fact are substantially correct and not misleading, and any material information which is a matter of expectation or belief (eg. an estimate or forecast) is provided in good faith.
Failure to disclose any material information or change in circumstances to Your insurers which could influence the cost, or their decision to accept Your insurance, could mean that Your policy could be invalidated or cancelled without refund, or that part or all of a claim may be not be paid.
‘Material statements’ and ‘material information’ are information which could influence the judgement of a prudent insurer in determining whether to take on a risk and on what terms.
Send
