Please Complete Your Details Below For A Quotation
Contact Name - Title & Surname:
Contact Name - First Name:
Name of Insured (if different):
Contact Number:
E-mail Address:
PROPERTY DETAILS
Address of Property to be Insured:
Postcode:
Approx. Date Property Built:
Sums Insured
Buildings Sum Insured (£):
Is Subsidence Cover Required?
Property Owners Liability:
Landlords Contents (optional) (£):
Property Details
Property Type:
Details of Tenants:
Occupancy Status:
Details if Unoccupied or Other:
Is the whole of the property to be insured?
Details if No:
Is any section of the property owner occupied and/or sold on a long lease?
Is the property let with more than one tenancy agreement?
If YES, to any of the above please give full details:
STATEMENT OF FACT
Comments
CLAIMS/LOSSES
Please details of ALL and ANY losses you have suffered or claims you have made in the last five years (please advise date(s), cost(s) and circumstances:
Any Additional Information/Comments:
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