Beazley Home insurance questionnaire risk
IN DECIDING THE PREMIUM AND TERMS ON WHICH TO OFFER THIS INSURANCE, INSURERS RELY ON THE INFORMATION YOU GIVE. YOU MUST TAKE CARE WHEN ANSWERING ANY QUESTIONS BY ENSURING THAT ANY INFORMATION PROVIDED IS ACCURATE AND, TO THE BEST OF YOUR KNOWLEDGE AND BELIEF, COMPLETE. FAILURE TO PROVIDE INFORMATION OR THE PROVISION OF INCOMPLETE OR INACCURATE INFORMATION MAY AFFECT YOUR COVER AND ANY CLAIM YOU MAY MAKE. PLEASE CONTACT YOUR BROKER IF YOU DO NOT UNDERSTAND A QUESTION OR THE NATURE OF THE INFORMATION REQUIRED. PLEASE ANSWER ALL THE QUESTIONS IN FULL AND TICK THE YES/NO BOXES AS APPROPRIATE. 1. Your details Full name (Mr/Mrs/Miss/Ms/Title): Joint proposer: Address: Postcode: Home telephone number: Work telephone number: Mobile telephone number: Email address: Date of birth: Address of premises to which this insurance is to apply (if different from above): Address: Postcode: PLEASE NOTE: IF MORE THAN ONE PROPERTY IS TO BE INSURED PLEASE COMPLETE A SEPARATE PROPOSAL FORM FOR EACH ADDRESS. Occupation: Please indicate the precise nature of business. It is not sufficient to state Secretary, Salesman, Company Director. Please also state in the space below if this occupation or any occupation of persons resident at the above address is conducted from your home and if so how many business visitors attend the property per week. Proposer: Occupation of partner or spouse (if applicable): Other occupants: Details of all other persons resident at the above address other than members of your family or resident domestic employees, whose property is to be insured: Name Relationship to proposer Occupation/Precise nature of business Interested parties: Please state the name and address of any party whose interest is to be noted under this policy i.e. mortgage lender:
2. Your home and its outbuildings The private dwelling at the address to be insured, including outbuildings (garages, stables, barns, studios, pool houses and other similar structures used for domestic purposes). PLEASE NOTE: IF YOU TICK ANY OF THE SHADED BOXES PLEASE PROVIDE FURTHER DETAILS IN THE SPACE AT THE END OF THIS SECTION. 1. Is the home and its outbuildings your main and permanent place of residence? If no, is it one of the following: Holiday home Weekend home Weekday home Let Other: 2. Is the home used for any business, trade or profession? 3. Are the gardens open to the public? Is the home open to the public? Do you hold any public events? Do you have any public rights of way through your property? 4. Is the home regularly unattended, other than during daytime working hours, and/or will it be left unoccupied for periods in excess of 60 days? 5. Are the buildings constructed of: Brick Stone Concrete Other: and roofed with: Slate Tiles Concrete Other: 6. Does the main dwelling have a flat felt or asphalt roof which covers more than 33% of the total roof area? (If yes, please confirm the percentage in the space provided.) Percentage of total roof area: 7. Are the outbuildings (garages, stables, barns, studios, pool houses or similar structures with a rebuild value of 50,000 or greater) constructed of brick, stone, concrete and roofed with slate, tile or concrete?* 8. Is the home in a good state of repair and regularly maintained? 9. How many bedrooms does the property have? 10. Has your home ever flooded? 11. Is your home built in an area historically free from flooding and coastal or river erosion and not within 400 metres of any river, stream or tidal waters? 12. Are the buildings free from signs of damage due to subsidence, heave or landslip (such as internal or external stepped or diagonal cracks), and not in an area where there has been evidence of these occurrences? 13. Are the buildings being monitored for subsidence, heave or landslip; have they ever been monitored for subsidence, heave or landslip, or suffered any subsidence, heave or landslip? 14. Has any survey carried out on your home ever reported settlement or movement of buildings? (If yes, please enclose a copy with this proposal.) 15. Are you aware that any neighbouring buildings have been the subject of an occurrence of subsidence, heave or landslip? 16. Are there any trees or shrubs within 7 metres (22ft.) of your home (whether inside or outside your garden) which are more than 3 metres (10ft.) tall? If yes, are the trees or shrubs within your boundaries? Yes No
Yes No 17. State the year the property was built: 18. Are any of the buildings or outbuildings listed? (Please give details and status in the space provided.) 19. Are you currently undertaking or planning to undertake any extensions, renovations or structural work? (If yes, please provide full details including the contract value) 20. Is your home a: Other: Detached house Semi-detached house Mid-terraced house End of terrace Maisonette Flat Bungalow Town house 21. If your home is a flat: Is it self-contained having its own lockable entrance under your sole control? Is it purpose built? Which floor is it on? If you have ticked any of the shaded boxes under Your home and its outbuildings, please give full details in the space below: Question No. Details
3. Protection of the premises Please answer the following questions regarding the level of security installed at your property. Yes No 1. Are final exit doors secured by mortice deadlocks (i.e. cut into the wood) with at least 5 levers or a rim deadlock conforming to British Standard 3621 or, if the door(s) are UPVC or double-glazed, a multi-point locking system with either a lever or built-in deadlocking cylinder? 2. Are all other external doors secured by a mortice deadlock (i.e. cut into the wood) or a deadlock conforming to British Standard 3621 or by a multi-point locking system with either a lever or built-in deadlocking cylinder or key-operated security bolts fitted internally to the top and bottom? 3. Are all opening sections of the basement, ground floor and easily accessible windows, fanlights and skylights to the buildings secured by key-operated window locks? 4. Are the premises to be insured fitted with a security alarm? If yes, please give details of the make and model number: 5. Is the alarm maintained under contract by an NSI, SSAIB or BSIA approved installer? Please state the type of alarm installed: Bells only Central station Redcare Digital communicator Packnet Connected to police Other: 6. Do you have a safe installed? If yes, please confirm the make, model number, type (i.e. freestanding, wall or under floor) and cash rating if known: 7. Do you have any of the following installed or in place at the premises to be insured? CCTV installed Infra-red lighting Security gates Building concierge None of these 8. Fire protections: Do you have any of the following in place? Battery or mains-operated smoke alarms If yes, how many? Central station fire/smoke alarms Fire blankets Fire extinguishers 9. Any other security or fire protections please provide details below:
4. Statement of values to be insured 1. Buildings The sum insured must represent the full cost of rebuilding your property and its outbuildings in their current form including any professional fees and site clearance. The buildings include all fixtures and fittings, tenant s improvements, fitted appliances, tennis courts, swimming pools, septic tanks, domestic oil or gas tanks, paved terraces, greenhouses, garden sheds, ornamental fountains and ponds, lampposts, house signs, drives, patios, paths, walls, gates, fences and interior decorations all owned by you or for which you are legally responsible. Also included are underground services, sewers, pipes, cables and drains which extend to the public mains. Outbuildings are defined as free-standing permanent structures including garages, stables, barns, studios, pool houses and other similar structures with a rebuild value of 50,000 or over. Tenant s improvements are defined as alterations, decorations or improvements which have been undertaken by you or previous occupiers as tenants but only if not covered by the landlord s or any other insurance. Main property: Outbuildings (if any): Tenant s improvements: Total: 2. Contents Your sum insured must represent the current cost of replacing, as new, your household goods, carpeting, furnishings, outdoor and garden property and other personal property including personal possessions designed to be worn or carried, pedal cycles and clothing belonging to you or for which you are legally responsible. Please ensure that the total sum insured for contents includes any items that fall within the following limits. These sums are included in, and will not increase, the contents sum insured that you request cover for. Certain contents items are limited as follows: Pedal cycles up to 2,500 any one cycle Valuables (jewellery, watches, furs and guns), gold, silver and gold and silver plated items up to 10,000 any one claim. Money up to 5,000 any one claim Credit cards (fraudulent or unauthorised use) up to 25,000 any one claim Outdoor and garden property (Items designed to be left or used outdoors including garden furniture, children s play equipment, statues and ornaments, domestic garden maintenance equipment, golf trolleys, golf buggies, motorised and non-motorised wheelchairs, motorised sit-in toy or miniature vehicles including motor-cycles providing they have an engine capacity of 50cc or less, quad bikes but only if used exclusively for the care of gardens, horses and pets; trailers and non-motorised horseboxes up to 12 ft in length) no more than 15,000 any one claim but no more than 7,500 for trailers, non-motorised horseboxes and ride-on mowers, and no more than 5,000 for quad bikes, motorcycles or golf buggies Business contents (Office furniture and equipment, stationery, office supplies, software, books, records and documents in your home) no more than 25,000 any one claim Wine 25,000 any one claim but no more than 500 for any one bottle Watercraft (Sailboards, surfboards, dinghies, hand-propelled and motorised boats of less than 16 ft in length, motorised watercraft with an engine of 25 horsepower or less including their furnishings, equipment and outboard motors) up to 7,500 any one claim Contents belonging to your parents or grandparents whilst in a nursing or residential care home up to 25,000 any one claim but no more than 2,500 any one item IMPORTANT NOTES TO ASSIST IN COMPLETING SECTION 2 (CONTENTS) IF HIGHER VALUES ARE REQUIRED ABOVE THE STATED CONTENTS LIMITS FOR ITEMS OTHER THAN VALUABLES AND FINE ART AND ANTIQUES PLEASE ADVISE YOUR BROKER. ANY PEDAL CYCLE EXCEEDING THE LIMIT OF 2,500 MUST BE INDIVIDUALLY SPECIFIED AT ITS FULL VALUE. Total of all contents to be insured:
3. Fine art and antiques Please only complete this section if you require cover for fine art and antiques. Fine art and antiques are any article of recognised artistic or collectable nature of whatsoever description other than jewellery, watches, furs and guns. This definition includes but is not limited to tapestries, rugs, furniture, paintings, etchings, manuscripts, sculptures, porcelain, gold, silver and gold and silver-plated items, objets d art, contemporary art, clocks and barometers and articles forming part of a collection. Total amounts required for all unspecified items (Items individually valued at less than 25,000.) Antique or designer-made furniture, tapestries, rugs, carpets or similar: Stamp and coin collections: Paintings, drawings, prints, etchings, photographs, books, manuscripts, etc: Sculptures, ornaments, porcelain and glass: Sculptures outside the home: Barometers, clocks, mechanical art and objets d art: Gold, silver, platinum, pewter and plate, precious stones or coins: Other collections or memorabilia (please specify): Unspecified total: All items of fine art and antiques individually valued at 25,000 or over must be specified in full giving a brief description and current market value in the space provided. If you need more space a list should be attached to this proposal together with valuations or purchase receipts (not more than five years old) for all specified items. Details of all fine art and antiques individually valued at over 25,000 to be specified. (Please use a separate sheet if required.) Description Value Specified total: Total of all unspecified and specified fine art and antiques:
4. Valuables Please only complete this section if you require a higher amount for jewellery, watches, furs and guns than the 10,000 sub-limit stated in Section 2 (Contents). Total amount required for all unspecified items (Items individually valued at less than 10,000) Watches and jewellery (permanently in a safe in the home): Watches and jewellery (permanently in a bank or safety deposit): All other watches and jewellery: Guns: Furs: Unspecified total: All items, pairs or sets individually valued at 10,000 or over must be specified in full giving a brief description and current market value in the space provided. If you need more space a list should be attached to this proposal together with valuations or purchase receipts (not more than five years old) for all specified items. Details of all valuables individually valued at over 10,000 to be specified. (Please use a separate sheet if required.) Description Value Specified total: Total of all unspecified and specified valuables:
5. Excesses Premium reductions may be available if you agree to accept a higher excess (the amount which you will be responsible for paying in the event of each and every claim). The standard excess applicable to this insurance policy in respect of subsidence, landslip or heave is 1,000. If your claim relates to an incident of loss or damage that falls for consideration under more than one section of cover and you have chosen different sectional excesses, it is the highest applicable excess that will be deducted from the total settlement. Please note higher excesses may be automatically imposed either for all claims or for certain perils such as subsidence, Please tick the appropriate box to indicate the excess you require for each section of cover. Buildings: 150 250 500 750 1,000 2,500 5,000 Other Contents/valuables and art and antiques: 150 250 500 750 1,000 2,500 5,000 Other 6. Previous insurance Please give the name of your previous insurer: Expiry date of policy: Total number of years you have held home insurance: Buildings: Contents: 7. Claims history Have you or any member of your family or any other person normally residing at the premises sustained any loss or (at the property to be insured, at a previous address or away from the home), amount and status (settled, declined, outstanding or not claimed for) of any loss or damage below: Type and brief description Date Location Amount Status mm/yy Buildings* Contents* Fine arts* Valuables* Liability* mm/yy mm/yy mm/yy * Please tick which type of cover your loss or damage fell under and if more space is required please use the notes page opposite. Total number of years since your last claim was made: Buildings: Contents: 8. General information Have you or any member of your family or any other person normally residing at the premises: Yes No 1. Had an insurer decline, cancel, refuse to continue, or agreed to continue only on special terms, any insurance? 2. Received a police caution and/or been convicted of or charged with, but not yet tried, for any offence other than a driving offence? 3. Has anyone whose property is to be insured ever entered into a voluntary arrangement with their creditors or been declared bankrupt? If you have answered yes, to 1, 2 or 3 above please give full details below:
European Union Disclosure Clause (UK) The parties of this insurance are free to choose the legal system that will apply to it. Unless specifically agreed to the contrary by underwriters, this insurance shall be subject to English law and subject to the exclusive jurisdiction of the courts of England. Data Protection Act 1998 Any information you have provided will be dealt with by us in compliance with the provisions of the Data Protection Act 1998. For the purpose of providing this home insurance and handling of any claims which may arise under it, underwriters may need to transfer certain information which you have provided to other parties. By signing this proposal you agree that such transfer(s) may be made. Declaration I/we declare that the information disclosed on this proposal, is to the best of my/our knowledge and belief both accurate and complete. I/we have taken care not to make any misrepresentation in the disclosure of this information and understand that all information provided is relevant to the acceptance and assessment of this insurance, the terms on which it is accepted and the premium charged. You must tell us as soon as possible about any changes in this information you have provided to us which happens before or during any period of insurance. We will tell you if such change affects your insurance and if so, whether the change will result in revised terms and/or premium being applied to your policy. If you do not inform us about a change it may affect any claim you make or could result in your insurance being invalid. I understand that the signing of this proposal does not bind me to complete the insurance but agree that should a contract of insurance be concluded, this proposal and statements made herein, will form the basis upon which cover, premium and terms will be determined. Commencement date of insurance required if accepted: Signature of proposer(s): Expiry date: Date: No cover is in force until this proposal is accepted by the insurer and the premium is paid. The insurer reserves the right to decline any insurance proposal or to offer different premium and terms from those quoted dependent on the information you have provided. Notes
CBPG086_UK_07/14