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House Insurance

Please complete this form to the best of your ability and giving as much detail as possible.

Your Details

Your Title
Your Full Name
Address
Postcode
Country
Telephone
E-Mail address
Date of Birth
Occupation

Property Details

Residence Type:
Time Unoccupied:
House Type:
Construction:
Roof Type:
Year Built:
Number of Bedrooms:
Is the property listed? Yes No
If so, which grade?
Has the property ever suffered from subsidence or undergone underpinning? Yes No
Is the area free from flooding? Yes No
Is the property self-contained and to be lived in by yourself and your family only? Yes No
Does the property have a flat roof? Yes No
If yes, what percentage of the roof is flat?
Neighborhood Watch Area ?: Yes No
Internal Door Locks? : Yes No
Window Locks? : Yes No
Burglar Alarm Fitted? : Yes No
Smoke Alarm Fitted? : Yes No
Business Use? : Yes No
Paying Guests? : Yes No

Contents Policy Details

Cover Type Required:
House Goods Sum Insured £s:
Personal Possessions Unspecified Away From The Home £s:
Specified Valuables Over £700.00:
Valuables In The Home Sum Insured £s:
Voluntary Excess £s:

Buildings Policy Details

Cover Type Required:
Sum Insured £s:
Voluntary Excess £s:
What date is the cover required from?

Claims

Date: Value £s: Reason:
Date: Value £s: Reason:
Date: Value £s: Reason:

 

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