Home Insurance Quotation Form

Please complete all the fields then press the submit button at the bottom of the page.

In providing our quotation we assume the following:-

• The building is built of brick with a tile roof.
• The building is not listed.
• You are not situated near a river or watercourse or in a flood risk area.
• The building is occupied solely by you and your family.
• You have not had any previous claims.

In all other cases please ring 01624 626 370 for your personal quotation.
Title: (Mr/Mrs/Ms)
Full name:
Address:
Post code:
Telephone number:
E-mail:
Date of birth: (dd/mm/yy)
Occupation:
Your partners name:
Date of birth: (dd/mm/yy)
Occupation:
Cover required:
Number of bedrooms:

Date property built:

Buildings
Buildings sum insured:
Is accidental damage required? yes no
How many years no claims bonus do you have?

Contents

Contents sum insured:
Is accidental damage required? yes no
How many years no claims bonus do you have?
Personal Possessions
Do you require cover for personal belongings away
from the home?		 yes no
If YES please
confirm sum insured:

Please specify any items
over £1,000 here: