HOUSE QUOTATION FORM
 
   
1. Name:
2. Address:
Post Code:
        Tel. Number:  
e-mail (if you have any):
3. Date of Birth
4. Sex:             Marital Status
5. Occupation:
   
   
6. Type of property:
Number of bedrooms:
7. How long have you lived at the propetry?
8. What is the construction of:
Walls:
Roof:
What percentage of the roof is flat?
      Year of build (approx.):
   
9. How many people occupy the home in total?   How many under 18?
10. What is the ownership status of the home?   Do you have a mortage? Yes No
11. Is the property your permanent residence? Yes No
12. Has the property been extended? Yes No
   
       
13. Is the property:
  A listed building? Yes No
  Near a riverbank/other watercourse? Yes No If yes distance from riverbank:
 

Unoccupied during the day?

 Yes No  
  Unoccupied at night? Yes No  
  Used for business purposes? Yes No  
  Free from subsidence/underpinning? Yes No  
  Free from flooding? Yes No  
  In a good state of repair? Yes No  
  Occupied by you and your family only? Yes No  
  Within 7 meters of any tall trees?
(over 5 meters tall)		 Yes No  
       
       
14. Which of the following security features do you have at the property?
  Smoke Detectors? Yes No  
  Alarm? Yes No If yes please state :
  Key operates locks on all doors & windows? Yes No  
  A Safe? Yes No  
  Security Lights? Yes No  
       
     
15. What sums insured do you require?
  Buildings: £
  Contents: £
16. Do you require accidental damage cover for:    
  Buildings: Yes No
  Contents: Yes No
17. Do you require cover for any valuables? Please enter the total sum: £
 
   
18. Have you previously held household insurance?         Yes No
19. How many years have you been insured without a claim for:
Buildings?    
Contents?    
20. Have you made any household insurance claims? Please enter dates, details and amounts paid.
If "Yes", please provide details and costs:
21. Does anyone living at the property smoke?       Yes No
22. Has anyone living at the property ever been convicted of / charged with any criminal offence other than motoring offences? Please enter details:

23. Has anyone living at the property ever had insurance withdrawn/refused or subjected to increased terms/conditions? Please enter details:

24. Has anyone living at the property ever had any financial or legal problems? Please enter details:
 

T: +44 (0)2920 702333   |   About Us   | Terms of Business Agreement  | 10 Reasons To Choose Us