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Full Name: |
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Company Name: |
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Company Status: |
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House Number/Name (Home): |
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Home Postcode: |
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Email Address: |
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Home Phone: |
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Mobile Phone: |
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Date of Birth : |
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Marital Status?: |
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Occupation/Business: |
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Address: |
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Postcode: |
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Required Start Date Of Cover : |
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How many years have you been a landlord?: |
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How many years experience do you have this in trade?: |
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Best quote so far?: |
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Where Is That Quote From?: |
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Have you made any claims or suffered any losses in the past 5 years?: |
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What is the Buildings sum insured (£): |
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What is the Contents sum insured (£): |
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Have you or you business partner/company director ever been declared bankrupt?: |
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Been convicted or have any prosecutions pending or been given an official police caution, in respect of any criminal offence other than motoring offence?: |
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Had any insurance proposal declined, renewal refused, had any special or increased terms applied or had insurance cancelled mid-term by underwriters?: |
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What is the address of the property that you wish to insure? |
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What is the postcode of the property you wish to insure?: |
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How long have you owned this property?: |
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Please select what type of property you are insuring?: |
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Please select the types of tenants that occupy your property?: |
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Type of tenancy Agreement?: |
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How many bedrooms does the property have? : |
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Are you the sole occupant(s) of the building in which your premises is situated?: |
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What year was the property built?: |
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Construction of the walls of your property including outbuildings?: |
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Construction of the stairs of your property?: |
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Construction of the roof of your property including outbuildings?: |
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Does the property have a basement?: |
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What percentage of the roof is flat? (if applicable) % : |
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What method of heating is used at the premises?: |
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Do you have an alarm fitted at your premises?: |
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If you have an alarm what type signalling does the system use?: |
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If you have an alarm do you have a maintenance contract in place?: |
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Who are your alarm maintenance company approved by? (if applicable)?: |
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Would you like you quote to include accidental damage?: |
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If you require cover for loss of rent please enter the annual rent £ |
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Is subsidence cover required?: |
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Best Time To Contact You?: |
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