HOME & CARAVAN INSURANCE QUOTATION
PROPOSER/S
Name
Occupation
D.O.B
1
2
3
4
CONTACT DETAILS
Tel
Fax
Mob
Email
Web
YOUR HOME
Address
Postcode
Adults
0
1
2
3
4
5
6>
Children (<18yrs)
0
1
2
3
4
5
6>
Type
Select Type
Detached House
Semi Detached House
Terraced House
Detached Bungalow
Appartment
Bedrooms
<1
2
3
4
5
6
7
8
9
10>
Heating Type :
Select Type
Oil
Gas
Electric
Solar Energy
Age(Yrs)
<1
2
3
4
5
6
7
8
9
10>
Confirm By Ticking Each Box That The Property...
Is not under renovation? :
Is not more than 4 storey's? :
Is not part flat roofed? :
Is not a listed building? :
Is in a good state of repair? :
Is built of brick, stone, concrete? :
Is roofed with slate, tile, or concrete? :
Is not subject to flooding or 250m from Water? :
Is not near cliffs, quarry or excavations? :
Is free from defects? :
Is not used as a holiday home? :
Is not occupied by paying guests/tenants? :
Is not unoccupied more than 60 days at a time? :
Is not used for business purposes? :
Is occupied only by Proposer/s or their relatives? :
If NOT Ticked Give Details In "OTHER INFORMATION"
SUM INSURED
Buildings Sum Insured = (Building+Out Buildings+Pathways+Drives)
BUILDINGS
Sum Insured
Is Accidential Buildings Damage Required
CONTENTS
Sum Insured
Is Accidential Contents Damage Required
PERSONAL POSSESSIONS
Sum Insured :
ALL RISKS
(Specified items exceeding £2500 in value)
1
:
2
:
3
:
4
:
HOME PROTECTIONS
Intruder Alarm Type?
Select Type
Bell Only
Central Station
BT Redcare
NACOSS Approved
Minimum 5 Lever Mortice Locks On All Doors
Windows Locks Installed?
Smoke/CO2 Alarms Installed?
Fire Protection Installed?
Neighbourhood Watch Scheme?
CARAVAN
(Static Site Only)
Type/Model
Age (Yrs)
Sum Insured
Site Name/Address & Postcode
INSURANCE HISTORY
Required Date
Current Insurer
Policy Num
Premium
Current Broker
CLAIMS RECORD
Tick if any claim in last 5 years
Give claim details, types, dates :
OTHER INFORMATION
Telephone 02870325999 for assistance