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Home Quotation
Name
Date of Birth
Occupation
2nd Insured (if applicable)
2nd Date of Birth
2nd Occupation

Address to be insured
Post  Code
Telephone Number
Daytime
  Evening
Cover Required Date

Type of Property
(ie detached semi terraced house bungalow)
Type of Construction
Number of Bedrooms
Year of Build
Permanent Home
Owned outright/mortgage/rented from private landlord/ rented from local authority
Unattended/Attended during working hours
Work from home?
Total number of Occupants
Occupants under 18
Do you have?
  
Paying Guests
Resident smokers
Smoke detectors fitted 
Does the property have any sign of subsidence/heave/landslip or flooding
Is your property fitted with approved locks
Are you situated in a neighbourhood watch area
How many years have you had Home insurance 
Do you currently have home insurance    
Would you like to pay your premium  (Monthly/Annually)
Please list any claims made in the last 3 years
COVER REQUIRED
  
Buildings value to insure for
Contents value to  insure for 

Unspecified personal items 

(cover away from the home)

 Items to be Specified over £1,500 (away from the home)
Cycles
Money/Credit Cards cover
   
NOTE: We will quote all cover on an a full accidental damage basis.