Home Insurance Quote If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required About You - please complete all fields in this section Title * Mr Mrs Miss Dr Rev Name * Address * Postcode * Tel * Email * Occupation * Date of birth * Marital status * Single Married Seperated Divorced Civil Partnership Other Have you ever been refused insurance * No Yes If yes please give details Do you have any criminal convictions * No Yes If yes please give details About Your Spouse/Partner - please complete if the policy will be held in two names Partner's title Mr Mrs Miss Dr Rev Partner's name Partner's Date of Birth Partner's occupation Has your partner ever been refused insurance Yes No Has your partner had any criminal convictons Yes No If yes please give dates and details Your Insurance Requirements Cover to begin on * How long have you owned The Property? * What is The Properties postcode * What type of property is it? * What is The Property constructed of? * Brick Stone Wood Glass Please select Yes if constructed of brick, stone or concrete and roofed with one of; slates, tiles,concrete or metal What type of roof does The Property have? * Tile Slate Glass Thatch How many bedrooms does The Property have? * Is The Property listed or historical? * Yes No What year was The Property built? * What is the rebuild cost of The Property? * How much contents cover do you require? * Do you require accidental damage cover on your contents? * Yes No How many years no claims do you have on your contents insurance? * How much Buildings Cover do you require? * Do you require accidental damage cover on your building? * Yes No How many years no claims do you have on your building insurance? * Do you require cover for personal posessions away from the home? * Yes No If so how much cover do you require for these items? Please list individual items over £1,000 and their values in the box below: * Has The Property suffered from subsidence? * No Yes If yes, please give details: Has The Property suffered from flooding? * No Yes Has The Property suffered from landslip? * No Yes Has The Property suffered from ground heave? * No Yes Has The Property ever been underpinned? * No Yes Is The Property near a river/quarry or the sea? * No Yes Is The Property fitted with 5 lever mortice locks? * No Yes Is The Property fitted with window locks? * No Yes Is The Property fitted with an intruder alarm? * No Yes Is The Property occupied during the day? * No Yes Have you made any claims on The Property in the last 5 years? * If so, what was the total value of these claim? Information about Your Insurance in general If any, who is your current insurer? If any, what is the best quote you have had?