Household Quotation Form
Please fill out the form below in as much detail as possible. Fields marked with a
YELLOW asterisk
are mandatory - and will enable us to complete a valid quote for you.
Proposer's Details
Title
Mr
Miss
Mrs
Ms
Rev
Dr
Fore Names
Surname
Full Address
*
Post Code
*
Home Telephone
Home Fax Number
Work Telephone
Work Fax Number
Mobile Telephone
*
E-mail Address
*
Date Of Birth
Occupation
Employed
Self Employed
Part Time
Unemployed
House Wife / Husband
In Full / Part Time Education
Unemployed Due To Disability
Retired
Voluntary Work
*
Type Of Business
*
First Time Buyer
No
Yes
Partner's Details
Title
Mr
Miss
Mrs
Ms
Rev
Dr
Fore Names
Surname
Date Of Birth
Occupation
Employed
Self Employed
Part Time
Unemployed
House Wife / Husband
In Full / Part Time Education
Unemployed Due To Disability
Retired
Voluntary Work
Not Applicable
*
Type Of Business
*
Present or Previous Cover Details
Contents Cover
Present / Previous Cover
New For Old
Accidental Damage
None
*
Present / Previous Insurer
To avoid contacting your present Insurer
eg. Sun Alliance -Not your insurance broker
Renewal Or Commencement Date
*
Renewal Premium £
Current Excess £
Number Of Claim Free Years
0
1
2
3
4
5
6
7
8
9
Max
*
Buildings Cover
Present / Previous Cover
Reinstatement
Accidental Damage
None
*
Present / Previous Insurer
To avoid contacting your present Insurer
eg. Sun Alliance -Not your insurance broker
Sum Insured £
Renewal Or Commencement Date
Renewal Premium £
Current Excess £
Number Of Claim Free Years
0
1
2
3
4
5
6
7
8
9
Max
*
Proposal Details
Postcode Of Property
Residence
Main Sole Occupancy
Main Co-Occupancy
Non Occupant
*
Accommodation
Mortgaged
Owner Occupied
Rented - Unfurnished
Rented - Furnished
*
Letting Status
Not Let
Let
Let Furnished
Let Unfurnished
*
Letting Type if applicable
Not Applicable
Local Authority
Privately
Tied
*
Business Use
None
Clerical Use
Full
*
Stock Amount £
Equipment Amount £
Approximate Year Built
*
'House' Type
Mansion
Detached House
Semi - Detached House
End Terraced House
Mid Terraced House
Maisonette
Semi Detached Maisonette
Mid Terraced Maisonette
End Terraced Maisonette
'Bungalow' Type
Chalet
Detached Bungalow
Semi - Detached Bungalow
End Terraced Bungalow
Mid Terraced Bungalow
'Flat' Type
Basement Flat Conversion
Basement Purpose Built Flat
Ground Floor Flat Conversion
Ground Floor Purpose Built Flat
Other Floor Flat Conversion
Other Floor Purpose Built Flat
Service Flat Within Employers Premises
Top Floor Flat Conversion
Top Floor Purpose Built Flat
If a Flat, is it...
Self Contained
Non Self Contained
'Other' Type
House Boat
Mobile Home
Static Caravan
other
Property Construction
Asbestos
Brick
Brick and Timber
Cob
Concrete
Corrugated Iron
Essex
Fibre Glass
Glass
Metal
Plastic
Prefab
Stone
Timber
Timber Frame
*
Roof Type
Asbestos
Concrete
Corrugated Iron
Felt
Fibre Glass
Plastic
Rigid Metal
Shingle
Slate
Thatched
Tiled
Timber
Turnerised
Woodwork
*
Number Of Bedrooms
*
When Is Property Unoccupied
Never
Day Time
Night Time
30 Days
60 Days +
*
Is It A Holiday Home
Yes
No
Claims
Have You Had Any Claims In The Last 5 Years
No
Yes
*
Claim / Accident
Claim Date
Amount Claimed
Brief Details
Claim / Accident 1
£
Claim / Accident 2
£
Claim / Accident 3
£
Claim / Accident 4
£
Claim / Accident 5
£
Cover Required
Contents
Total Value Of Household Contents £
Cover Required
Not Required
New For Old
New For Old with Accidental Damage
*
Voluntary Excess £
£50
£100
£150
£200
Buildings
Cover Required
Not Required
Reinstatement
Reinstatement and Accidental Damage
*
Voluntary Excess £
£50
£100
£150
£200
Buildings
Sum Insured £
To Calculate Your Buildings Sum Insured Figure
Please Click
HERE
Security Details
ALL the following Security questions are Mandatory and
are required for your quotation.
Door Locks Fitted To BS 3621 To
FINAL
Exit Door
Yes
No
(5 lever mortice or equivalent)
Door Locks Fitted To BS 3621 To
OTHER
Exit Door
Yes
No
(5 lever mortice or equivalent)
Patio Doors
Yes
No
Windows Locks Fitted
Yes
No
Burglar Alarm
Yes
No
If yes, NACOSS approved
Yes
No
Is this under a maintenance contract
.
Yes
No
Neighbourhood Watch Scheme Member
Yes
No
Smoke Alarms Fitted
Yes
No
In accordance with ABI regulations the quote will be sent to you by post with
a prospectus and proposal form.