Household Insurance Quote Form Ref: Babraham 2015 Please complete all of the following information in order for us to provide you with our most competitive quotation. Personal Details: Title: Full Name: Date of Birth: Marital Status Occupation: Policyholder Joint Insured Contact Details: Address: Phone Number(s): E-mail address: Preferred method of contact (please tick)?: Email: Phone: Declaration We will assume that the following statements are true, unless stated otherwise in the additional details box on page 5: You, or anyone living at the property, have never had a proposal for household insurance refused or declined. You, or anyone living at the property, have never had a renewal for household insurance refused. You, or anyone living at the property, have never had household insurance cancelled or declared void. You, or anyone living at the property, have never had special terms or conditions imposed for household insurance. You, or anyone living at the property, have never received any non-motoring criminal convictions or police cautions that are not spent. You, or anyone living at the property, have never been cautioned for or charged but not yet tried for any non-motoring offences. You, or anyone living at the property, have never been declared bankrupt or insolvent as a private individual or in connection with any business. You, or anyone living at the property, have never been the subject of a court judgement in respect of debt either as private individual or as a business. 1
Property Details: Is the risk address your main residence? If not, please advise the intended use for the property (i.e. unoccupied, let, holiday home etc.) Is the risk address to be unoccupied for longer than 30 consecutive days? What is the type of property (i.e. detached, house, flat, bungalow etc.)? What year was the property constructed? Have any extensions been added to the property? Are there any plans to carry out any building works or refurbishments within the next 12 months? If so, please provide details: Is the property standard construction (i.e. brick walls, tile roof)? If not, please provide details of construction: Is the property listed? If so, to what grade is it listed? How many bedrooms does the property have? Is there any business activity carried out at the property? If so, please provide details: Has the property ever suffered from any previous damage caused by subsidence, heave or landslip? Is the property within 400m of any watercourse (i.e. lake, stream, river etc.)? Has the property ever suffered from any previous damage caused through flooding? 2
Does the property have any trees situated taller than 7m within 25m of the property? If so, please provide details, including approximate height, distance and species of each respective tree: Is the property in a good general state of repair? Is the property occupied during the day? What date is cover required from? Do all entrance and exit doors have five lever mortice deadlocks fitted? Do all accessible windows have key operated locks fitted? Is there an intruder alarm system fitted? If so, is the alarm NACOSS approved and maintained under an annual agreement? Is the alarm linked to a receiving centre? Are there smoke detectors fitted? If so, are these mains or battery operated? Are you a member of a Neighbourhood Watch scheme? Is there a safe fitted at the property? If so, please provide the make, model and cash rating: Claim(s) Details: Please provide details for any loss, damage, injury or liability, whether insured or not, sustained within the last five years. This applies to anyone living at the property. Date Brief Description of Claim Cost 3
Buildings Section: Please note that the Building sum insured must cover the total cost required in order to rebuild the main property as well as subsequent outbuildings. This includes site clearance fees, specialist fees, architect fees and VAT. Buildings sum: Do you require Accidental Damage cover under the Buildings section? Is there a Financial Interest to be noted on the policy (i.e. mortgage)? If so, please provide details: Contents Section: Please note that Contents sums insured must be sufficient so as to cover the replacement for all Contents on a new for old basis. Please confirm the sums insured required including details of Valuable items such as Fine Art & Jewellery as summarised below. (NB Valuable items are subject to a Single Article limit which can vary so this will be discussed) Contents sum (excluding Fine Art & Jewellery): Antique Furniture: Paintings: Books: Coin Collections: Stamp Collections: Porcelain & Fragile Items: Gold, Silver & Plated items: Rugs & Tapestries: Clocks & Barometers: Jewellery: Do you require Accidental Damage cover under the Contents section? 4
Unspecified Personal Possessions: Cover can be arranged for items that are taken away from the property in order to protect them against theft, accidental damage and accidental loss. These can be items that are taken away on a daily basis, such as handbags, mobile phones, i-pods and jewellery, as well as items that may be taken abroad such as luggage, clothing, digital cameras and camcorders. You must consider the total value of the items that you will have with you at any one time, whilst also considering that items taken from the property will be subject to a single article limit of 1,500. Any item that exceeds this limit would need to be specified in order to ensure that sufficient cover is in force. Unspecified Personal Possessions sum: Specified Personal Possessions sum: Additional Details: Signature: Date: 5