Your Details
TitleMrMrsMissMsDr
Initial(s)*
Surname*
Address 1*
Address 2
Address 3
Town/City
Postcode*
County
Daytime Tel No.*
Email*
Date of Birth
Occupation
First Time Buyer?noyes
About Your Property
Property TypeDetached HouseSemi-Detached HouseTerraced HouseEnd Of Terrace HouseMaisonetteDetached BungalowSemi-Detached BungalowFlat - Ground Floor or BasementFlat - 1st Floor or Above
No. of Bedrooms12345More Than 5
Period BuiltPre 18371837 - 19191920 - 19451946 - 19791980 - 19891990 Onwards
Standard Constructionyesno
If the property is not of a standard construction, please specify details of construction, and tell us if your property is thatched.
Previous Claims
Have you had any claims within the last 3 years?noyes
If yes, please provide details of any claims including dates, type of claim and cost
Sums Insured
Building (re-instatement cost, not purchase price)
Content (Replacement Costs)
Unspecified All Risks miscellaneous items up to £1000 each)
Specified All Risks (Specified items, each valued over £1000)
Item 1 / Value
Item 2 / Value
Item 3 / Value
Item 4 / Value
Item 5 / Value
Is accidental damage cover required?yesno
Is subsidence cover required?yesno
Additional Details
Name of present insurers
Renewal Date
Premium Paid Last Year
Please leave this field empty.