LET RESIDENTIAL INSURANCE QUOTATION
PROPOSER
Name
T/as
Trade
Sole Trader
Partnership
Limited
Trading Since
Terrirtory
UK Only
UK & ROI
ROI Only
YOUR ADDRESS
Address
Postcode
CONTACT DETAILS
Tel
Fax
Mob
Email
Web
THE PROPERTY
Address (
The Property To Insure
):
Postcode
Property Age
<1
2
3
4
5
6
7
8
9
10>
Property Type
Select Type
House
Bungalow
Flat
Bedsits
Heating Type
Select Type
Oil
Gas
Electric
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 :
Is not near cliffs, quarry or excavations :
Is free from defects :
Is not used as a holiday home :
If NOT Ticked Give Details In "OTHER INFORMATION"
SUM INSURED
(Reinstatement = Buildings+Out-Buildings+Pathways+Drives)
BUILDINGS
(Reinstatement) Sum Insured :
Is Accidential Buildings Damage Required
CONTENTS
(Reinstatement) Sum Insured :
Is Accidential Contents Damage Required
LOSS OF RENT
Property Annual Rental Income :
TENANCY
Type Of Occupancy
Select Type
Let Property
Unoccupied
Let Commercial
Type Of Tenant
Select Type
Professional
Retired
DSS Benefit
Foreign National
Vacant
Asylum Seeker
Probation
Mixed
Number Of Tenants
0
1
2
3
4
5>
Is A Tenancy Lease/Agreement In Place
Duration of Lease/Agreement
Select Type
None
Less Than 6 Mths
More Than 6 Mths
Long Term
Is Sub Letting Allowed
PROTECTIONS
Intruder Alarm Type
Select Type
Bell Only
Central Station
No Alarm
Minimum 5 Lever Mortice Locks On All Doors
Windows Locks Installed
Smoke/CO2 Alarms Installed
Fire Protection Installed
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