Quote Request for Contents Insurance Use this form for Dual Buildings & Contents insurance
To enable us to supply a quotation please complete the following:
Name Title E-mail In case we need to contact you for further information please tell us your daytime telephone number:
In case we need to contact you for further information please tell us your daytime telephone number:
Please check you enter your E-mail address correctly.
Date cover required from:
Address:
Your postcode:
Your date of birth:
Occupation:
Are You?
Employers business:
State occupancy details:
Enter the year your house was built:
Type of property:
Standard Construction? If no give details in the MATERIAL FACTS box at end of form:
How many bedrooms?
Is your house left unoccupied on a daily basis?
Buildings Value
What cover required for the building?
Contents Value
What cover required for the contents?
Details of any valuable or collection that exceeds 20% of the contents sum insured:
Do you require any items to be covered on an "All Risks" basis. These are normally items that are taken from the home i.e. jewellery, cameras etc.?
If you have answered "yes" to All Risks cover please give details of items to be covered, including total value of all articles with a value of less than £500. Items over £500 should be detailed with value of each item:
Do you have any of the following? Yes No I have key operated window locks. Yes No I have 5 lever mortise locks on external doors. Yes No I have a NACOSS approved alarm. Yes No I belong to a neighbourhood watch scheme. How many years claim free? Any previous claims made should be disclosed, including dates, and amount paid. Please indicate the current premium of your policy: £
Do you have any of the following?
How many years claim free?
Any previous claims made should be disclosed, including dates, and amount paid.
Please indicate the current premium of your policy:
IS YOUR E MAIL ADDRESS CORRECT?
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