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Home Insurance
YOUR
D
ETAILS
Name :-
Address :-
Date of Birth :-
Telephone :-
E-mail :-
PROPERTY TO
BE INSURED
Address of property to be insured :-
Is this your main residence ? :-
select
Yes
No
Owner Occupied?
Rented Accommodation?
Type of property :-
select
Detached
Semi-Detached
Terraced
Apartment
No of bedrooms :-
Standard Construction ? :-
Yes
No
Construction details if non standard :-
Alarm Installed ? :-
No
Yes
Is Alarm NSAI approved and fitted ? :-
No
Yes
Is Alarm connected to monitoring station ? :-
No
Yes
Security locks on doors & windows ? :-
Yes
No
Smoke Alarms fitted ? :-
Yes
No
Neighbourhood watch ? :-
Yes
No
COVER REQUIRED
Cover* required for BUILDINGS :- IR£
Cover* required for CONTENTS :- IR£
Personal Effects Away from the Home:- IR£
Frozen Foods :- IR£
Sports Equipment :- IR£
Unspecified Valuables :- IR£
Specified Items
Item :-
Value :- IR£
Item :-
Value :- IR£
Item :-
Value :- IR£
Item :-
Value :- IR£
Please provide details of any claims made during the last five years :-
