ABOUT
YOU
Your
name:
Your
business name, if any:
Address line 1:
Address
line 2:
Town
or City:
Postcode:
E-mail:
Daytime
telephone:
Best
time for us to telephone you:
Any Time 9.00am to 5.00pm
Morning 9.00am to Noon
Lunchtime Noon - 2.00pm
Afternoon 2.00pm - 5.00pm
Please
describe the owner's occupation (aside
from property owner!):
ABOUT
THE PROPERTY TO INSURE
Address line 1:
Address
line 2:
Town
or City:
Postcode:
Which year
was the property built?
How
many flats are there?
How many
floors are there?
Is there
a lift?
Yes
No
Is the
building purpose-built block of flats?
Yes
No
If no purpose built, which year
was the property converted?
Is the
building fully occupied?
Yes
No
Aside
from working tentants, retired tenants and
owner occupiers, please
describe any other occupiers
No other type
DSS
Asylum Seekers
Students
A mixture of DSS and students
A mixture of all of the above
What
is the construction of the walls?
Brick
Cob
Other
Stone
Timber
What
is the construction of the floors?
Timber
Concrete
Construction of the pitched roof, if any?
Tile
Metal
Slate
Thatch
Not pitched - 100% flat
Other
What
percentage of the roof is flat?
None
Under 20%
Between 21% and 30%
Between 31% and 40%
Between 41% and 50%
Over 50%
What
is the construction of the flat roof, if any?
Please advise
the re-building cost £
Is it a "listed" property
No
Yes
Does
it have 5 lever mortise deadlocks on all final
exit doors and key operated locks on all accessible
windows
No
Yes
Double-glazed doors with multi- point locking
are also acceptable
Has
the area ever been flooded?
No
Yes
Is subsidence
cover required?
No
Yes
Not
available if the property or surrounding
area, been affected by subsidence, landslip, heave
or settlement
Is Employers
Liability cover required?
No
Yes
Is
Terrorism cover required?
No
Yes
Rent insurance sum
insured £
Leave blank if not required
Communal
area contents sum insured £
Leave blank if not required
How much
excess do you require ?
Please select
£100 or less
£250
£500
£1,000
£5,000
£10,000
Please select
Have you had any claims in the past 5 years?
No Yes
Please advise the date, what happened and how much was paid out:
If
there is anything we have failed to ask but could
affect your quotation, please enter details in the
area below. This will help us give you a more accurate
quotation.
Lastly! Advise the
name of your current insurers (and broker) and
best quote so far
