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Home Insurance Quotation

Your details:
Name:
Title:
Address:
Town:
County:
Postcode
Date of Birth:	(dd/mm/yy)
Gender:
Marital Status:
Occupation:
Contact Phone Number:
Email Address:

Please answer the following questions
Have you ever been refused home insurance by any insurer?		(yes/no)
Have you every had any insurance cancelled or renewal refused by any insurer?		(yes/no)
Have you ever had any special conditions or terms imposed by any insurer?		(yes/no)
Have you ever been cautioned, convicted or have pending any prosecution for dishonesty?		(yes/no)
Have you ever been convicted or have pending any prosecution for arson?		(yes/no)
Has the property ever been affected by subsidence, heave, landslip or flood?		(yes/no)
Is there any history of subsidence, heave, landslip or flood in the area surrounding your property?		(yes/no)
Is the home in a good state of repair?		(yes/no)
Is the home to be maintained in a good state of repair?		(yes/no)

The Property is
Type of Property
House Number/Name
Postcode
Is this your main residence?		(yes/no)
How many people live in the property?
What are the walls made from?
What is the roof made from?
What year was the property built?		(yyyy)
How many bedrooms?

Do you require contents cover?		(yes/no)
Date you wish contents cover to commence?		(dd/mm/yy)
Amount of cover required away from home (all risks)?		(£)
Who is your current insurer?
How many years no claims do you have?
Do you require bicycles to be covered?		(yes/no)
If so value?		(£)
Do you require buildings cover?		(yes/no)
Date you wish buildings cover to commence?		(dd/mm/yy)
Property rebuilding cost?		(£)

Residents
Which of these statements apply to you?
I share the property with my partner/family only		(yes/no)
I share the property with other people		(yes/no)
Is the property used for business?		(yes/no)
How long is the property ever left unoccupied for?		(months)
Have you made any claims in the last 5 years?		(yes/no)
If so details here
Do you require legal expenses?	(yes/no)

Security
Main entrance door?
Other external doors?
Patio doors?		(yes/no)
Accessible windows?
Burglar Alarm fitted		(yes/no)
If yes what kind?
Is there a neighbourhood watch scheme?		(yes/no)
Do you have a smoke alarm fitted?		(yes/no)

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