Home Insurence Quote Home Insurence form About the propertyIs the property to be insured your main place of residence and will it be occupied solely by you, your partner and family members?(Required) Yes No House Name or Number(Required) Do you require insurance because:(Required)I am a landlordProperty is a holiday homeProperty is Vacant / UnoccupiedHouse Name or Number(Required) Street(Required) Town(Required) Postcode(Required) What type of property is this?(Required)DetachedSemi DetachedTerraceDetached BungalowSemi BungalowQuasi SemiTownhouseSelf Contained FlatOther FlatBedsitHalls Of ResidenceMarried QuartersBarracksB and BPark HomeWindmillCastelHouseboatLighthouseIs the property situated more than 400 metres from any river, sea or watercourse?(Required) Yes No Is this a listed building?(Required)Not ListedEnglish Grade 1 ListerEnglish Grade 2 ListerEnglish Grade 2* ListerEnglish Grade A ListerEnglish Grade B ListerEnglish Grade C ListerHow many rooms does the property have?(Required)What year was the property built?(Required)How many bedrooms does the property have?(Required)How many bathrooms does the property have?(Required)01234567How was the property built?(Required)StandardTimber FrameStandard ThatchWaterReed ThatchCanadian CedarCedar Roof/BrickColt CompanyCedar Walls/SlateOther Non StandardWhat are the external walls built with?(Required)BrickBrick / TimberConcreteStoneTimber PlasterAsbestosCOBCorrugated IronEssex constructionFibreglassFlintGlassMetalPlasticPrefab (Combustible)Prefab (Non-Combustible)StandardStramitAll TimberTimber FrameTimber Frame(Built After 1975)Wattle & DaubWoodwallWoodworkOtherWhat is the roof made of?(Required)TileSlateAsphaltConcreteThatch FibreThatch ReedFelt>AsbestosCorrugated IronFibreglass (1979 and prior)Fibreglass (1980 and post)GlassMetalPlasticShingleStandardStramitTimberTurnerisedWoodworkOtherWhat percentage of the roof is flat?(Required)None1% – 20%21% – 40%41% – 50%Over 50%Is the property in a good state of repair and free from flood, subsidence, heave, landslip, tall trees and neighbouring subsidence?(Required) Yes No Is there any building work in progress?(Required) Yes No Is the value of the work being carried out over £25,000?(Required) Yes No About safety and securityIs a burglar alarm installed?(Required)Approved and Maintained AlarmApproved and Maintained Alarm with 24hrBasic DIY AlarmNo AlarmWill fit an AlarmDoes the property have operational smoke detectors?(Required)NoPartial (Some Levels)Yes (All Levels)Is the property fitted with five-lever mortice deadlocks on all final exit doors, and key-operated window locks on all ground level windows and accessible upper floor windows?(Required) Yes No Is the property covered by a Home Watch scheme?(Required) Yes No Living in and Use of the PropertyDo you own or rent the property?(Required)OwnedRentedLeasedAre you a first-time buyer?(Required) Yes No When is the property normally occupied?(Required)Occupied Day and NightDaily UnoccupancyLengthy UnoccupancyNightly UnoccupancyHow many days in a row is the property left empty (e.g. holidays)?(Required)60 days or lessMore than 60 daysHow many adults live at this address?(Required)123+How many children live in the property?(Required)123456Does anybody in the property smoke?(Required) Yes No Is the property used in connection with any business?(Required) Yes No Is the business use solely clerical with no employees or visitors?(Required) Yes No Do you have a mortgage?(Required) Yes No Your CoverWhen would you like your insurance policy to begin?(Required) DD dash MM dash YYYY Have you ever been refused home insurance, or ever had an insurance policy voided or cancelled?(Required) Yes No What type of cover do you require?(Required)Building and ContentsBuildingContentsContents CoverHow much would you like to insure your household contents for?(Required)How much cover do you require for personal belongings outside the property?(Required)5001,0002,0003,0004,0005,0006.0007,0008,000Do you require accidental damage cover?(Required) Yes No What level of voluntary excess are you willing to accept in return for a possible premium reduction?(Required)5001,0002,0003,0004,0005,0006.0007,0008,000Have you held contents insurance within the last three months?(Required) Yes No How many continuous years have you held claims free contents insurance?(Required)None1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years or OverWhen does your previous contents policy expire?(Required) DD dash MM dash YYYY Do you require cover for any individual item, worth £2,000 and over, in your home?(Required) Yes No Specified Contents Item Category(Required)Dependants Contents @ College/UniversityGold/Silver/Precious MetalsOther High Risk/Valued ItemsPictures In ContentsSpecified ContentsItem Description(Required) What would it cost to replace this item (if possible) or what is the current value of it?(Required)Do you require cover for any individual item outside your home?(Required) Yes No Item Category(Required)Any Works of ArtCar RadioComputer EquipmentContact LensesCyclesElectrical (Exc. Hifi/TV/Video)FursGlasses, MonoclesGold, Silver and similar metalsGolfing EquipmentGunsHifi, TV and Video EquipmentHigh Risk Sports EquipmentJewellery UK/EuropeJewellery UK/Europe+60 Days WWJewellery WorldwideJewellery at The BankMisc. ItemsMoney in the BankMusical InstrumentOther Items (Exc. from Quote)Photographic EquipmentPorcelainPortable Medical EquipmentPortable/Mobile TelephonesSports Equipment (inc. High Risk)Stamp, Coin and Medical CollectionsVideo Cameras and EquipmentItem Description(Required) What would it cost to replace this item (if possible) or what is the current value of it?(Required)Claims HistoryHave you made any household insurance claims in the last five years?(Required) Yes No When was the claim made?(Required) DD dash MM dash YYYY Claim Description(Required)Alternative AccomodationAccidental DamageAdditional ExpensesAccidental LossBurst BoilerBurst PipeBurst TankDeep Freeze ContentsDamage To JewelleryDamage To Spectacles/Contact LensesEarthquakeExplosionFire DamageFlood DamageFrost DamageFlight DelayHoliday CancellationHijackImpact DamageLegal ExpensesLiabilityLoss of JewelleryLoss of RentLoss of Spectacles/Contact LensesLightening DamagesMalicious DamagesMedical ExpensesPersonal AccidentPedal Cycle Claim (Excluding Theft)Storm DamageSubsidenceTheft DamageTerrorismTheftTheft of Pedal CycleTransit DamageTheft From VehicleVehicle BreakdownVeterinary FeesWater DamageWhat type of claim was it?(Required)BuildingsContentsWhat was the value of the claim?(Required)Insurance Payment MethodHow did you pay for your previous insurance?(Required) Pay in Full Direct Debit Your Personal DetailsTitle(Required)MrMrsMsMissMxDoctorProfessorSirFirst Name(s)(Required) Surname(Required) Gender(Required) Male Female Date of Birth(Required) DD dash MM dash YYYY Have you been a permanent resident of the UK since birth?(Required) Yes No When did you become a UK resident?(Required) DD dash MM dash YYYY Marital Status(Required)SingleMarriedDivorcedWidowedCivil ParentedContact InformationWhat type of property is this?(Required)HouseBoat/BargeCaravanChaletFlatHalls of ResidenceHouseboatLicensed PremisesMarried QuartersNo Fixed AbodeSquatStatic CaravanDaytime telephone number(Required) Evening or mobile phone number(Required) Email address(Required) Employment InformationWhat is your employment status?(Required)Club or AssociationDirectorEmployeeFull Time EducationGovernmentHousePersonLimited CompanyOtherProprietor or PartnerRetiredSelf EmployedUnemployedWhat is your occupation?(Required) What is your employer's business? e.g. Retailing(Required) Your business type(Required) Line of Business(Required) Do you have a Part-Time or an Additional Job?(Required) Yes No Do you want to include another person (e.g. joint policy owner)?(Required) Yes No Part-time Employment InformationWhat is your part-time employment status?(Required)Club or AssociationDirectorEmployeeFull Time EducationGovernmentHousePersonLimited CompanyOtherProprietor or PartnerRetiredSelf EmployedUnemployedWhat is your part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is your part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is your part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is your part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is your part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is your part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is your part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is your part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is your part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is your part-time employer's business? e.g. Retailing, Insurance or Building Trade(Required) What is your part-time employer's business? e.g. Retailing, Insurance or Building Trade(Required) What is your part-time employer's business? e.g. Retailing, Insurance or Building Trade(Required) What is your part-time employer's business? e.g. Retailing, Insurance or Building Trade(Required) What is your part-time employer's business? e.g. Retailing, Insurance or Building Trade(Required) What is your part-time business type? e.g. Retailing, Insurance or Building Trade(Required) What is your part-time business type? e.g. Retailing, Insurance or Building Trade(Required) What is your part-time business type? e.g. Retailing, Insurance or Building Trade(Required) What is your part-time line of business? e.g. Retailing, Insurance or Building Trade(Required) Joint PolicyholderTitle(Required)MrMrsMissMsMxProfessorDrSirFirst name(s)(Required) Surname(Required) Gender(Required) Male Female Date of Birth(Required) DD dash MM dash YYYY Have they been a permanent resident in the UK since birth?(Required) Yes No When did they become a resident?(Required) DD dash MM dash YYYY Marital Status(Required)SingleMarriedDivorcedWidowedCivil PartneredTheir relationship to you(Required)SpouseSiblingParentOffspringCommon Law SpouseCivil PartnerNoneEmployment InformationWhat is their employment status?(Required)Club or AssociationDirectorEmployeeFull Time EducationGovernmentHousePersonLimited CompanyOtherProprietor or PartnerRetiredSelf EmployedUnemployedWhat is their occupation?(Required) What is their occupation?(Required) What is their occupation?(Required) What is their occupation?(Required) What is their occupation?(Required) What is their occupation?(Required) What is their occupation?(Required) What is their occupation?(Required) What is their occupation?(Required) What is their employer's business? e.g. Retailing(Required) What is their employer's business? e.g. Retailing(Required) What is their employer's business? e.g. Retailing(Required) What is their employer's business? e.g. Retailing(Required) What is their employer's business? e.g. Retailing(Required) What is their business? e.g. Retailing(Required) What is their business? e.g. Retailing(Required) What is their business? e.g. Retailing(Required) What is their line of business?(Required) Do they have a Part-Time or an Additional Job?(Required) Yes No Part Time Employment InformationWhat is their part-time employment status?(Required)Club or AssociationDirectorEmployeeFull Time EducationGovernmentHousePersonLimited CompanyOtherProprietor or PartnerRetiredSelf EmployedUnemployedWhat is their part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is their part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is their part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is their part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is their part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is their part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is their part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is their part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is their part-time occupation? e.g. Sales Manager, Computer Programmer or Plumber(Required) What is their part-time employer's business? e.g. Retailing, Insurance or Building Trade(Required) What is their part-time employer's business? e.g. Retailing, Insurance or Building Trade(Required) What is their part-time employer's business? e.g. Retailing, Insurance or Building Trade(Required) What is their part-time employer's business? e.g. Retailing, Insurance or Building Trade(Required) What is their part-time employer's business? e.g. Retailing, Insurance or Building Trade(Required) What is their part-time line of business?(Required) DeclarationsHave you or any of the joint Policy owners, or anyone usually living in the property, been declared bankrupt or had a County Court Judgement (CCJ) or Individual Voluntary Arrangement (IVA)?(Required) Yes No Have you or any of the joint Policy owners, or anyone living with you, been convicted of any offence (other than a motoring offence) that is not regarded as spent under the Rehabilitation of Offenders Act 1974?(Required) Yes No In the last five years have you or any of the joint Policy owners, or anyone living with you, had any type of insurance policy voided or cancelled because you or they have provided inaccurate or incomplete information to an insurer?(Required) Yes No
