Holiday Home Insurance Quote Form

Please Read This Statement Before Completing The Form

The quotations we provide you will be based on the following:

You have never been made bankrupt or have any criminal convictions.
You have never been refused any insurance, had a policy withdrawn or had and special terms imposed to an insurance policy?.
The property is in a good state of repair and will be so maintained.
The property has never been underpinned.
The property has never been repaired, monitored in connection with, or suffered damage by subsidence, landslip or ground heave.

N.B. If you cant agree with the above statement or are not sure about the statement then please ring us on 01288 353999 where we will be more than pleased to offer a quotation over the phone.

Proposer's Details

Proposer's full name:

Date of birth:

Occupation:

Employers business:

Joint Proposer's Details ( If Applicable ).

Joint proposer's full name:

Date of birth:

Occupation:

Employers business:

Risk Address Details

Risk address/Property to insure:

Risk postcode:

Property type:

Construction (Walls):

Construction (Roof):

What percentage flat roof is on the property?

Year property originally built:

Has the property ever been extended?

YesNo

If Yes, What was the extension and what year was the extension built?

Is the property a listed building?

Number of bedrooms:

Final exit doors fitted with 5 lever mortice approved deadlocks (Standard BS3621):

Key operated locks on all accessible windows:

Is the property in a neighbourhood watch area:

Do you have smoke alarms fitted:

Is the property within 400 metres of a river, watercourse, sea, cliff or quarry, or in a flood or subsidence risk area?

YesNo

If Yes, Please add further information here (e.g. 100 metres from the nearest river, etc)

Do you own the property outright or on a mortgage:

Cover Details

Buildings: This is the full rebuilding cost of your property, including private outbuildings, gates, fences and swimming pools. It's not the current market value of the property.

Contents: This covers all personal contents in the holiday home (i.e. furniture, carpets, TV's etc).

Do You Require Buildings Cover?:

If Yes, Buildings Sum Insured?: £

Do You Require Contents Cover?:

If Yes, Contents Sum Insured?: £

Have you made any claims on any household insurance policy within the last 5 years?

YesNo

If Yes, Please add claims details here inc exact date, circumstances and claim amount.

Other General Details

Is the property self contained with it's own lockable entrance door?:

YesNo

Is the holiday home used exclusively by you and members of your family or friends?:

YesNo

Or holiday let or lent on a commercial basis through the year?:

YesNo

How long have you owned this property?:

Current insurers (If applicable):

Policy number on current policy (if applicable):

Start/Renewal date:

Target/Renewal premium: £

Please add any further information you feel we need to know about which you feel may affect the quotation?:

Contact Details

Contact Name:

Correspondence home address:

Email address:

Phone number:

How to contact you:

Holiday Home Insurance Quotation Form

Please Read This Statement Before Completing The Form

Proposer's Details

Risk Address Details

Cover Details

Other General Details

Contact Details

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