Title

 Forename

 Surname

 Date of Birth

 Contact Telephone No.

 Occupation

 Are you a homeowner? Yes    No

 Do you have a mortgage? Yes    No

 Mortgage Provider (If yes to above)

   Mortgage Renewal Date (if known)

Cover Required Fields marked with are required.

Buildings Cover (sum assured) £

Buildings Accidental Damage

Contents Cover (£15,000 - £100,000) £

Contents Accidental Cover

Personal Items (£2,500 - £10,000) £

Claims / Loss Information Fields marked with are required.

 Are you a first time buyer and will this be your first home insurance policy? Please Select Yes No

 

 Number of claim/loss free years for Buildings insurance? Please Select 0 1 2 3 4 5 More than 5

 

 Number of claim/loss free years for Contents insurance? Please Select 0 1 2 3 4 5 More than 5

Property Information Fields marked with are required.

 Property Type? Please Select Above Second Floor Above Second Floor Flat Conversion Above Second Floor Purpose Built Flat Basement Flat Conversion Basement Purpose Built Flat Bay Fronted Detached House Bay Fronted End Terrace House Bay Fronted Mid Terraced House Bay Fronted Semi Detached House Building Under Construction Chalet Detached Bungalow Detached House Detached Maisonette End Of Terrace Maisonette End Terraced Bungalow End Terraced House First Floor First Floor Flat Conversion First Floor Purpose Built Flat Flats Conversion To Existing Dwelling Ground Floor Flat Conversion Ground Floor Purpose Built Flat House Boat Maisonette Mansion Mid Terrace Maisonette Mid Terraced Bungalow Mid Terraced House Mobile Home Other Floor Flat Conversion Other Floor Purpose Built Flat Purpose Built Flat Residential Caravan Rooms Second Floor Second Floor Flat Conversion Second Floor Purpose Built Flat Semi Detached Bungalow Semi Detached House Semi Detached Maisonette Service Flat Within Employers Premises Show House Top Floor Flat Conversion Top Floor Purpose Built Flat Unknown Unspecified Private Dwelling Zz Not Covered By Any Other Item On The List

 Property Post Code

 Number of Bedrooms

 Approx Year of Construction (e.g 1985)

 Buy to Let Status Please Select N/A Homeowner or Tenant(Contents only) Let to Employed Persons Full or Part time Let to Self Employed Persons Let to Students Let to Retired Persons Let to Benefits Assisted Persons Permanent UK Resident Let to Others

 Final Exit Door Lock Type Please Select Any Other Lock Type 3 Bolt Multipoint Locking System Mortice Deadlock 5 Or More Levers BS3621 Rim Lock Automatic Deadlock BS3621

 Window Lock Type Please Select Any Other Lock Type Key Operated Window Locks No Window Locks Fitted

Declaration Questions Agree Disagree

Your property is built of brick, stone or concrete and roofed with tiles or slates with no more than 30% of the roof being flat.
There are no cracks or bulges in the walls and it has not been underpinned or monitored for subsidence, heave, or landslip and is in an area which is free from flooding and coastal or riverbank erosion.
You and anyone residing at your property have not had special terms imposed by your insurer, or had insurance declined, cancelled or refused.
During the last 3 years you and anyone residing at your property have not had more than one claim or loss or had any claim or loss costing more than £750.
The property to be insured is purely occupied for residental purposes and not left unoccupied for more than 30 consecutive days.
Your property is in a good state of repair, will be so maintained and is not undergoing any renovation or construction work.
You and anyone residing at your property have not sustained a non motoring conviction (current or pending).

Additional Information

Please enter any additional information in the text area below.(eg. if you disagreed to any of the declaration questions, please state why).