Property Owners Insurance Quotation form

Name of the Individual(s) / Company the policy is to be in *

Risk Address including postcode *

Contact Number *

Your Email Address *

Please confirm Renewal / Inception date

What describes your property type *

Year the premises was built

Number of years you have owned the premises *

Please provide the number of flats *

Is the request to insurer the whole of the property

YesNo

Number of floors *

Construction of floor

Rebuilding sum insured *

Do you require loss of Rent coverYesNo

Please advise the loss of rent cover

Indemnity Period (Months)

Property Owners Limit of Indemnity

We have made the following assumptions

Is following information is correct?

YesNo

1) The premises are not a Listed Building

1) Are the premises listed

2) The premises has fixed Gas Central heating

2) Please confirm the type of heating a the premises

2) The heating is fixed heating

Please confirm the type of fixed heaters - fuel type

3) The proposer, director or partner of the Trade or Business or its Subsidiary Companies has never personally or in any business capacity:

- been convictions of a criminal offences which are not spent under the Rehabilitation of Offenders Act or has any prosecutions pending

- been declared bankrupt or insolvent or been the subject of bankruptcy proceedings or insolvency proceedings

- had a proposal refused or declined - had an insurance cancelled - had a renewal refused - had special terms imposed

YesNo

4) There has been no losses or incidents giving rise to a claim in the last 5 years

YesNo

Please provide details of the claims including loss date, type of loss and amount paid and outstanding

5) The premises are not in an area with a history of flooding

YesNo

6) The property is of standard construction, the walls are built of brick, stone or concrete and the roof is slate, tile or concrete with 0% of flat roof

YesNo

Wall construction

Roof construction

% of the roof which is felt on timber

7) The property and adjacent property have not suffered or shown any visible signs of damage from subsidence, landslip or ground heave

YesNo

Any additional information you would like to provide

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