Please note that we only deal with customers residing within the UK, Isle of Man and Channel Islands

House, Buildings & Contents Insurance Quotation Form

Your email:
Title:	Forename:	Surname:
Address:	City:	Postcode:
Phone:	Occupation:	Date of Birth:
Buildings:
1. What is the full rebuilding cost of your home?
2. Do you require accidental damage cover?
3. What type of property is your home?		Other, please specify:
4. In what year was your property built (please give approximate date if unknown):
5. How many bedrooms does the property have?
6. Is the property standard construction? (If not please provide further details at the end of the form)
7. Is the property occupied solely by you and your family? (If not please provide further details at the end of the form)
Contents:
8. What total sum insured do you need to replace all the contents of your home?
9. Do you want to include accidental damage cover? (This is not available if the property is rented)
DO YOU REQUIRE ALL RISKS ON PERSONAL POSSESSIONS (outside of the home)?
10. Unspecified Jewellery, Personal Effects & Clothing. (Any items over £1000 in value have to be specified):
11. Have you suffered loss or damage or liability in the past five years which has resulted in a claim under your Household Insurance? (If yes please provide further details at the end of the form)
12. What is the renewal date and current premium of your existing insurance?
Buildings:	Renewal Date:	Premium:
Contents:	Renewal Date:	Premium:
Further details - if applicable: (Please indicate the question to which you are referring next to the information)

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Buildings: