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Home Insurance Quote
 
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Home Insurance Quote Form

For UK Customers Only

Please insert your details here and we will provide you with a competitive home insurance quote shortly from our wide range of insurers.

This quotation form is designed for insuring your main residence/home for buildings and/or contents and not for properties let to tenants.

If you have any problems completing this form, please phone us on 01623 641 386 for assistance.

Proposer's Details

1st Proposer's Details
Status:
First Name:
Surname:
Marital Status:
Address of property to be insured:
Postcode: Help?
Is the correspondence address the
same as the address shown above?
Yes     No
Correspondence address:
(if different from above)
Date of Birth:  (dd/mm/yyyy)
Occupation:
Employer's Business:
Employment Status:
Do you live permanently
at the address to be insured?
Yes     No
If no, please provide details:
Do you wish to add a second proposer?Yes     No
2nd Proposer's Details
Status:
First Name:
Surname:
Relationship to Proposer:
Date of Birth:  (dd/mm/yyyy)
Occupation:
Employer's Business:
Employment Status:
Contact Details
Daytime Telephone No.:
*E-Mail Address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.

General Information

Preliminary Information
Have you, or any other family member ever been convicted of any offences, or had any insurance refused, cancelled or special terms applied?Yes     No
If yes, please provide details:
(e.g. type of incident, date(s), fines,
custodial sentence, terms applied, etc.)
Have you, or any other family member ever been made bankrupt or had a county court judgement (CCJ)?Yes     No
If yes, please provide details:
(e.g. date(s), amounts of bankruptcy,
has the bankruptcy been discharged,
have any CCJ's been paid, etc.)
Year Built / Property Type
Approximate year the property was built: (yyyy)
Type of property:
Property Construction
Construction of Walls
Construction of Roof
Percentage flat roofing (if applicable):%
No. of bedrooms:
No. of bathrooms (incl. en-suites):
Number of storeys:
Has there ever been any subsidence,
landslip, ground heave or flood
damage at the property or nearby?
Yes     No Help?
If yes, please provide details:
Is the property
in a good state of repair?
Yes     No
If no, please provide details:
Is the property near a river or quarry?Yes     No
If yes, please state whether
near a river or a quarry
and the approximate distance:
Is the property grade listed?
(e.g. grade I, II, etc.)
Has the property ever been underpinned?Yes     No
If yes, please provide details:
Use / Occupancy
Property ownership:
Occupancy:
Is the property currently occupied?Yes     No Help?
If no, please provide details of how
long it has been unoccupied and how
long before the property will be occupied:
Is the property ever
unoccupied for more than 30 days?
Yes     No
If yes, please provide details:
Is any business use
carried out from the premises?
Yes     No
If yes, details of business activities:
Is the property used as a
holiday home or a second home?
Yes     No
Is the home occupied
by paying guests / lodgers?
Yes     No
If yes, number of paying guests / lodgers:
Do you, or any other persons
who reside at the property smoke?
Yes     No
Security
Is the property self-contained
with its own lockable entrance?
Yes     No
Level of security:
(Tick all that are applicable)
NACOSS/NSI approved alarm fitted
Smoke Detectors
Member of Neighbourhood Watch
5 Lever Mortice Locks (B.S. 3621) for Exterior
      Doors and Key Operated Window Locks
Type of locks on patio doors:
(If no patio doors, please select 'No Patio Doors' from the dropdown list)
Surveys / Extensions
Have any surveys or engineers
reports been carried out on the property?
Yes     No
If yes, please provide details:
Has the property ever been extended?Yes     No
If yes, year extended:
Insurance History
Do you currently hold home insurance?Yes     No
If yes, please indicate how many
years you have held home insurance:
Claims History/Experience
Have you or any other person living in the
property had any household claims, loss,
damage or any other incidents suffered
in the last 5 years whether the loss,
damage or incident was insured or not?
Yes     No Help?
If yes, please provide details:

Buildings Insurance Details (for home owners only)

Buildings Sum Insured (£'s) (Standard Perils Cover) Help?
Is Accidental Damage Cover Required?Yes     No

Contents Insurance Details

Contents Sum Insured (£'s) (New for Old Cover) Help?
Is Accidental Damage Cover Required?Yes     No

Extra Cover (optional)
 
Is Cover Required for your Personal
Possessions away from your home?
(e.g. clothing, jewellery, etc.)
Yes     No Help?
Please state the sum insured
required for unspecified personal
possessions away from the home:
(Minimum level of cover is £2,000)
Pedal Cycles
Would you also like to include cover
for pedal cycles away from the home?
Yes    No
Number of pedal cycles:
Highest value pedal cycle to be insured:
 
Specified Item(s)
Individual valuables or jewellery are usually restricted to £1,500 per item unless specified.
Do you wish to specify
any valuables or jewellery?
Yes     No
Please provide details of any special items / valuables over £1,500 that you wish to specify on your policy:
ItemDescription (e.g. 18ct gold ring)Value (£'s)
1.
2.
3.
4.
5.
6.
 
Legal Cover
 
Is £50,000 home legal cover required?Yes     No
 
Renewal/Cover Start Date

Renewal date / cover start date: (dd/mm/yyyy)
Current annual premium / best quotation:
This may help us to get you a better quote
Preferred payment method:Annually     Monthly by Direct Debit

Request Quotation

Disclosure
Please ensure that you have answered all the questions honestly and to the best of your knowledge, then press the Request Home Insurance Quotation button and we will contact you shortly with a quotation.