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Property Owners Insurance Quote Request Name of Property OwnerN.B. Please state if the property owner is an individual, partnership, limited company etcFirst NameSurnameEmail AddressContact NumberCurrent Insurance2day Policyholder?YesNoWhich of the following are you? Property Owner Property Developer Property Manager Housing Association Residants Association Other - please provide details Details if other:Property Address (inc Postcode)Correspondence AddressPlease carefully review the Statement of Fact below and advise if you do not agree with ALL of the statements: A. No partner, director or any other person responsible for the property which is the subject of this insurance proposal, or any other business in which you, or they, have been trading: 1. Have any convictions, criminal offences or prosecutions pending, other than motor offences, or received an official caution within the last three years 2. Have been declared bankrupt/insolvent, or the subject of bankruptcy proceedings 3. Have been officers of a company that has been declared insolvent, or had a receiver, administrator or liquidator appointed, or entered into arrangements with creditors in accordance with the Insolvency Act 1986 or any subsequent legislation 4. Have been the subject of a county court judgement (CCJ) in respect of debt, either as private individuals or in connection with any business 5. Have been the subject of a recovery action by Customs and Excise or the Inland Revenue 6. Have been disqualified under the Company Directors Disqualification Act 1986 or any subsequent legislation 7. Have had a proposal refused or declined or ever had an insurance cancelled, renewal refused, a claim repudiated or special terms imposed 8. Have been officer of a company subject to Prohibition or Enforcement action by any regulatory bodies or been served with a prohibition or improvement notice B. The property: 1. Is of non-combustible construction with no composite panels 2. Is not built on made up ground 3. Is not located in an area with a known history of subsidence; has no visible cracks; and the property or any adjacent property has not previously suffered from any subsidence, heave or landslip 4. Is not in an area previously affected by flood 5. Does not have any high risk adjoining or neighbouring premises 6. Is maintained in a good state of repair C. You comply with the requirements of the Regulatory Reform (Fire Safety) Order 2005 (or any similar, equivalent or subsequent legislation) and UK health and safety legislation D. All Material Facts have been disclosed Once you have carefully reviewed the Statement of Fact, please Select from the options below:Please choose:YES, I agree with the Statement of FactNO, I do not agree with the Statement of Fact, for the reasons detailed belowPlease provide full details of any of the statements you do not agree withPrevious / Current InsurerRenewal Date / Date Cover RequiredYear of BuildIs the property Listed?NoYes, Grade IYes, Grade II*Yes, Grade IIPurchase DateNoted Interest (if applicable)Property Type Commercial - Detached Commercial - Semi-Detached Commercial - Terraced Commercial - With Flats Above Flats - Converted Mansion Flats - Converted Flats - Purpose Built Flat - Individual Flat - Holiday Home House - Bedsits House - Multiple Occupancy House - Semi-Detached House - Terraced House - Holiday Home Industrial Unit - Detached Industrial Unit - Adjoining Others Office - With No Flat(s) Above Office - With Flat(s) Above Shop - With No Flat(s) Above Shop - With Flat(s) Above Surgery - With No Flat(s) Above Surgery - With Flat(s) Above Warehouse - Detached Warehouse - Adjoining Others Other - please provide details Details, if OtherOccupancy Details Private Rental Students Local Authority Council Support Care and Support Bed and Breakfest Asylum Seekers Leasehold Commercial Tenancy Industrial Tenant Holiday Home - Own Use Only Holiday Home - Own Use & Family & Friends Holiday Home - Own Use & Let to Others Other - please provide details Details, if OtherDetails if Commercial, Industrial or OtherOccupany Status Occupied Unoccupied - Pending Tenants Moving in Within 2 Weeks Unoccupied - Pending Tenants Moving in Within 4 Weeks Unoccupied - Pending Reletting Unoccupied - Pending Sale Unoccupied - Pending Rennovation (no Structural Works) Unoccupied - Pending Rennovation (inc Structural Works) Holiday Home Is the tenancy/lease agreement directly between the landlord and tenant?YesNo - please provide detailsN/ADetails if Commercial, Industrial or OtherIs the tenancy/lease agreement for a minimum of 6 months?YesNo - please provide detailsN/ADetails if Commercial, Industrial or OtherIs sub-letting permitted?YesNoIs a full repairing lease in place?Details% Flat RoofChooseNo Flat Roof AreasLess than 10%Less than 15%Less than 25%Less than 30%Less than 50%Less than 100%100% FlatFlat Roof ConstructionTimber & FeltConcreteOtherN/ADetails, if otherNumber of concrete floor storeys123+Number of wooden floor storeys123+Is the property heated solely by Mains Supply Gas Central Heating?YesNoIf No, please confirm all of the Types of Heating Radiators - Hot Water Radiators - Oil filled Night Storage Heaters Fire - Open Fire - Other Fixed Heaters Portable Heaters - Electric Portable Heaters - Gas Pressure Jet Heaters Hot Air Oil Heaters Radiant Panel Heaters Stove / Wood Burner Other - please provide details Satisfactory Electrical Installation Condition Report?YesNoNot KnownATM on Premises?YesNoN/ASprinkler System?YesNoN/ADetailsScope of Insurance Cover - Please Select from the Additional Cover Options BelowAccidental Damage?YesNoSubsidence?YesNoSprinkler Leakage?YesNoTerrorism?YesNoN.B. Terrorism cover may need to be quoted as a separate policySums InsuredBuildings Sum Insuredi.e. the total cost to re-build the premises, including debris removal and professional fees, not the market value of the propertyLandlord's Contents Sum Insuredi.e. floor coverings, light fittings etc and other property owned by the landlord that don't form part of the building Loss of Rent Receivable - Annual SumLoss of Rent Indemnity Period12 Months24 Months36 MonthsN/AProperty Owners Liability£1,000,000£2,000,000£5,000,000£10,000,000Employers LiabilityNot Needed£10,000,000£15,000,000If Employers Liability cover is required, please provide details of the estimated annual wages / payments to labour only subcontractors below and confirm the number of employees:Clerical and AdministrationProperty Maintenance - ex Work at HeightRoofers and/or Window CleanersOther Wages - please provide detailsClaims / Loss Experience (irrespective of whether a claim has been made)Claims / Loss Experience (irrespective of whether a claim has been made)YesNoIf Yes, did they relate to this risk address?YesNoN/AHas this risk address ever flooded?YesNoPlease Provide the Date(s) of Loss, Costs, Details and Any Preventative MeasuresComments / Additional InformationCAPTCHA
Please carefully review the Statement of Fact below and advise if you do not agree with ALL of the statements: