Home Insurance Quote Form

Home Insurance Quotation Request Form

Arrange a free quote for your home insurance. Simply complete the quotation form below, submit the form to us and we’ll come back to you shortly. A trained advisor manually checks and reviews each quote to provide peace of mind and ensure you have appropriate cover levels.

This form is for single homes lived in by the proposer. If this is not the case then please call us to discuss or look through our site for a more appropriate product.

1Policyholders

2Risk Address

3Cover

4Disclosures

5Contact

Step 1. Policyholders Details

The name the home insurance will be in.

How Many Policyholders Are There?: *

If the buildings are owned, all owners should be listed. If more than policyholders please call us to discuss.

PROPOSER 1 - Title: *

Proposer 1 - Full Name: *

First

Last

Proposer 1 - Sex: *

Proposer 1 - Date Of Birth: *//

Day / Month / Year

Proposer 1 - Occupation: *

Proposers occupation.

Proposer 1 - Employers Business: *

Employers Business.

Proposer 1 - Employment Status: *

Employment Status.

PROPOSER 2 - Title: *

Proposer 2 - Full Name: *

First

Last

Proposer 2 - Sex: *

Proposer 2 - Date Of Birth: *//

Day / Month / Year

Proposer 2 - Occupation: *

Proposer 2 occupation.

Proposer 2 - Employers Business: *

Employers Business.

Proposer 2 - Employment Status: *

Employment Status.

PROPOSER 3 - Title: *

Proposer 3 - Full Name: *

First

Last

Proposer 3 - Sex: *

Proposer 3 - Date Of Birth: *//

Day / Month / Year

Proposer 3 - Occupation: *

Proposers occupation.

Proposer 3 - Employers Business: *

Employers Business.

Proposer 3 - Employment Status: *

Employment Status.

Have You Made Any Claims On Any Household Policy In The Last 5 Years?: *

Any claims or losses made in the last 5 years.

If Yes To Claims, Please Supply Full Description Of Losses Including Dates, Costs And Payments Made: *

Please supply dates, circumstances, costs involved and any remediation work that has been undertaken, if any, to stop a similar loss occurring again.

Step 2. About Your Home

Please answer the below questions about your home as honestly and accurately as possible. Failure to do so could see your policy cancelled or a claim being rejected.

Risk Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Property Use / Occupancy?: *

Please Confirm Mortgagee / Interested Party Name. *

Date Purchased Or Moved In To The Home?: *//

Day / Month / Year

What Year Was The Property Built?: *

Please put approx. date if exact date not known.

Is The Property A Listed Building?: *

E.G. Yes, Grade 2 listed

What Grade Listing?: *

What Type Of Property Do You Live In?: *

Please describe the type of property you live in.

Construction Of The Property - WALLS ?: *

Construction Of The Property - ROOF ?: *

Does The Premises Have Any Flat Roof Area?: *

This could be any flat roof type, felt on timber etc

What Percentage (%) Of The Roof Is Flat?: *

Flat roof conditions will apply including regular inspections by a building contractor, roofer, or surveyor. Failure to comply with conditions may result in a claim being declined.

How Many Bedrooms Are In The Home?: *

How many bedrooms are in the bedrooms? Rooms that would be classed as a bedroom if you marketed it, but not used as a bedroom should be classed as a bedroom for insurance purposes.

How Many Bathrooms Or Shower Rooms Are In The Home? *

Any room that has a fitted shower or bath in it.

Is The Property Within 400 Metres Of Any Watercourse, Sea, River, Stream, Lake Or Similar?: *

If unknown, a good way of checking is putting your postcode in to Google Maps.

If Yes, Please Confirm What You Are Close To, How Far Away You Are, And How High The Property Is Above The Water Level. *

Are You Aware Of Any Previous Flooding AT The Premises, Whether Or Not It Was Insured And Whether or Not A Claim Was Made?: *

Add full details about previous flooding: *

If property previously flooded please add full details here including dates, circumstances and damage, costs involved and what's been done since to help minimise flooding in the area including flood defences.

Are The Premises In A Good State Of Repair?: *

Has The Property (Or Neighbouring Property/Area) Ever Suffered From Subsidence, Landslip Or Heave, Or Has The Property Been Underpinned Or Being Monitored?: *

Add Full Details About Previous Subsidence, Landslip Or Heave In The Area Here, Underpinning Or Monitoring Of The Property: *

Include works that have been done to stop future damage at the property

Is The Property In A Neighbourhood Watch Area?: *

Do you know if the property is in a registered Neighbourhood Watch Area (NHW).

Does The Property Have Smoke Alarms Fitted?: *

Does the property have working smoke alarms fitted

Has The Property Ever Been Extended?: *

Does the property ever knowingly been extended

Year Property Was Last Extended?: *

Please add the year the property was extended

How Is The Premises Heated?: (Please select all that apply) *

How is the premises heated? (Use CTRL + Left Click Mouse for multiple choices.)

Do You Rent Out Any Rooms Or Is Any Business Operated From The Property?: *

Any business use from the property, or rent rooms or take in lodgers?

If Yes to Business or Let Rooms, Please give full details below: *

Describe exactly what business is run from property or how rooms are let.

Step 3. COVER REQUIRED

Buildings Cover.

Do You Own The Building?: *

Either owned outright or on a mortgage

Are You Looking To Insure The Building On this Policy?: *

If YES, What Sum Insured Required For 'Buildings'?: *

Should represent the full rebuilding cost of the property including debris removal, and architect and surveyor fees.

Do You Require 'Accidental Damage' Cover?: *

Covers Accidental Damage caused to the buildings (if owned)

How Long Have You Had Continuous Buildings Insurance?: *

How many years have you had continuous buildings insurance

Contents Cover.

Do You Require Cover For Your Contents In The Home?: *

What is your 'Contents' Sums Insured?: *

This should represent the full replacement value of all your contents, including carpets, furniture, electricals, jewellery, etc.

Do you Require 'Accidental Damage' Cover On Contents?: *

Covers Accidental Damage of contents.

How Long Have You Had Continuous Contents Insurance?: *

How many years have you had continuous contents insurance.

Personal Possessions Cover.

Do You Require Cover For Portable/Personal Possessions Whilst Taken OUTSIDE The Home?:?: *

If Yes, Whats The Maximum Value Of Possessions You'd Take Away At Any One Time?: *

Maximum total value you'd take away at any one time. Anything individually over £1,500 or any bikes valued over £500 please specify in the next section.

Are Any Items Taken OUTSIDE The Home Valued Over £1500 or Bikes Over £500?: *

Any portable possessions valued over £1500 or £500 for bikes.

If Yes Please Detail These Items And Confirm Their Current Market Value: *

Describe the items over the single article limits and confirm their current values. An up to date valuation may be required for these items and cover conditions may be applied.

Do You Require 'Household Legal Expenses' Cover?: *

Cover typically includes employment disputes, boundary disputes, contract disputes, and much more. Each policy varies so please check any cover is adequate for your needs.

Step 4. Disclosures.

Please answer the questions below in respect of the owners or proprietors, failure to disclose information could lead to claim being refused.

A) Ever Been Convicted Of, Cautioned Or Have A Prosecution Pending For Any Criminal Offence Other Than Motoring Offences? *

If Yes to A), please give full details including dates, circumstances, fines etc *

B) Been Declared Bankrupt Or Been The Subject Of Bankruptcy proceedings, An Administrative Receivership, A Company or Partnership or Individual Voluntary Arrangement, A Debit Relief Order, An Administration Order, A Compulsory Liquidation, A Creditors Voluntary Liquidation, A Winding Up Order Or Any Equivalents in Scotland or Northern Ireland? *

If Yes to B), please give full details *

Include dates, full circumstances, costs involved, and if fully settled.

C) In The Last 5 Years Had A Policy Voided, Renewal Declined, Cancelled Where A Cancellation Clause Has Been Invoked Or Had Special Terms Imposed By An Insurers?: *

If Yes to C), please give full details: *

Includes dates, full circumstances and reasons.

Do You Have Any Further Information Or Material Facts That You Feel Could Impact An Insurers View Of The Risk?: *

If Yes, please add any further information here: *

Any information you feel could have an impact on an underwriters views of the risk.

Final Step. Contact Details & Previous Cover

Please provide details so we can come back to you with our best quote or if we need more information.

Contact Name: *

First

Last

Your Email Address: *

Contact Telephone Number: *

Policy Start Date: *

Renewal or inception date of your policy:

Do You Have An Existing Insurance Policy Coming Due For Renewal Soon?: *

Who Are Your Current Insurers?: *

What's Your Renewal Or Target Premium?: *

Where Did You Hear About Our Company?: *

Finally, Marketing and Quotes

Yes, I'm happy for contact by EMAIL.
Yes, I'm happy for contact by PHONE.
Yes, I'm happy for contact by NEWSLETTER.
Yes, I'm happy for contact by SMS TEXT.

We're highly protective of your information, we never pass your details to anyone else. We may occasionally contact you with exciting products for property owners, update you with the latest property insurance news or to maybe contact you another year for a quote on your property. If you're happy please click the appropriate boxes above.

Need Assistance?

If you’re unsure with any questions or would prefer to speak with one of our advisors please give us a call on 01288 353999.

Opening Hours.

Mon-Fri: 9am – 5pm
Sat: 9am-12pm
Sun: Closed

Step 1. Policyholders Details

Step 2. About Your Home

Step 3. COVER REQUIRED

Buildings Cover.

Contents Cover.

Personal Possessions Cover.

Step 4. Disclosures.

Final Step. Contact Details & Previous Cover

Need Assistance?

Opening Hours.

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