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Proposer's name: |
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Date of
birth: |
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Occupation: |
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Employer's business: |
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Is there a joint proposer? |
Yes
No |
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If Yes: Joint proposer's name: |
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Date of birth: |
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Occupation |
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Employers business: |
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Correspondence address:
(if different from risk address) |
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Correspondence postcode: |
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About The Property
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Address of property to be insured: |
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Risk postcode: |
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Date property
purchased or to be purchased: |
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What is the length of your
lease agreement with tenant?: |
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The lease agreement is between
you and........ ?: |
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Type of tenant that will
occupy the home?: |
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What is or will be the tenants occupation? |
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Type of property: |
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Bedrooms: |
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Year property was built: |
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Is the property a listed building? |
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Construction of property (walls)? |
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Construction of property (roof) |
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What percentage of the total roof is flat? |
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How many storeys are there in the property? |
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Cover |
Buildings: This must represent the full
re-building costs of the property, including debris removal and
architects fees.
Contents: This covers your own contents within the property, i.e.
carpets, blinds, curtains, furniture etc.
Loss Of Rent: This covers what you will lose out in rent in
the event your property becomes uninhabitable after an insured peril.
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What cover do you require?: |
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If Buildings cover is
required, What Sum Insured?:
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If Landlords Contents cover is
required, What Sum Insured?: |
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What is the estimated 'rental income' for the
next 12 months? |
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Other Information
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Have you incurred any
loss, made any claim, or had a claim made against you in the last
5 years?: |
Yes
No |
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Is the property close to a river, watercourse,
sea, cliff or quarry or in a flood risk area? |
Yes
No |
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Has the property suffered or any neighbouring
properties suffered with any damage caused by subsidence, heave or
landslip or had any underpinning or remedial action done to the
property? |
Yes
No |
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Have you ever been declared bankrupt, gone in
to liquidation or had an insurance policy declined, refused, cancelled
or had special terms imposed or been convicted of any offence (excluding
motoring convictions)? |
Yes
No |
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If you have answered
'Yes' to the above questions, please give full details here,
including dates, costs, circumstances and distances etc:
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Inception/Renewal Date for
policy: |
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Current insurers (If
applicable): |
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Renewal/Target premium: |
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Preferred payment method for
insurance policy: |
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