Email Address Name Address Postcode Date of birth Occupation Do you own the property? yesno Is it mortgaged? yesno Is the property unoccupied Type of property detachedsemi detachedhousebungalow Member of Neighbourhood Watch Scheme? yesno Five lever mortise deadlocks on all doors / window locks fitted? ( minimum security) yesno Do you have an alarm? yesno If so, type (ie NACOSS approved) Do you have a smoke alarm? yesno Do you wish to have a voluntary excess, ie £100? yesno Used for business? yesno Are there paying guests? yesno Number of adults Number of children Previous insurance NCD When was the property built? How many bedrooms? Sum Insured? Are there any signs of subsidence? yesno Is the property of standard construction, ie brick built/slate roof? yesno Does the property have a flat roof area? yesno If so, what % of whole Is Accidental Damage cover required? yesno Contents: Sums insured required? Contents: Accidental Damage cover required? Personal belongings cover required(ie cover for valuables outside the home) yesno Sums insured required for personal belongings? Any high risk items? yesno If so, provide details When is cover required from? What is your renewal premium / quoted premium? Any claims on either section? yesno If so, state date and amount claimed Additional Comments
