Insured or Company name:
Company status:
Contact Telephone Number:
Mobile Number:
Fax Number:
Email Address:
House Number / Property Name:
Street:
Town:
County:
Postcode:
House Number / Property Name:
Street:
Town:
County:
Postcode:
Person's Contact Name:
Position / Title:
Nature of Business:
Business Established:
Reason for Quotation
Information about the Property to be
Insured:
Type of Property
Type of Construction
Number of bedrooms
Buildings
Subsidence Cover Required
Contents
Replacement value of landlords contents
What type of tenants do you expect to have
How long have you owned the property
Is the property in a good state of repair, free
from storm/flood,subsidence,landslip,ground heave and movement
Have you ever had Insurance denied, cancelled
or refused by any insurance company?
Have you made any Claims in the Last 5 Years?