Private clients - HOME INSURANCE QUOTE Please take a few moments to complete the details below, upon receipt your dedicated account manager will contact you to provide your bespoke home insurance quotation. Full Name: Daytime contact telephone: e-mail address: What title should we use for you: House number / name: Postcode: Date of birth: 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 Commencement date for cover: 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 2010 2011 2012 Do you require buildings insurance, contents cover or both: - Please Select - Buildings only Buildings and Contents Contents Only What type of property do you wish to cover: - Please Select - House Detached House End-Terraced House Mid-Terraced House Semi 1st Floor Flat Conversion 1st Floor Purpse blt Flat 2nd Floor Flat Conversion 2nd Floor Purpse blt Flat Above 2nd Floor Flat Conversion Above 2ndFloor Purpose built Bay Fronted Detached House Bay Fronted End Terce Hse Bay Fronted Mid Tercd Hse Bay Fronted Semi Det. Hse Building Under Construction Bungalow Detached Bungalow End-Terraced Bungalow Mid-Terraced Bungalow Semi Chalet Flat Basement Conversion Flat Basement Purpose Built Flat Grnd Flr Conversion Flat Grnd Flr Purpose Built Flat Top Floor Conversion Flat Top Floor Purpose Built Flats (Conv Exist Dwell) Mansion Purpose built apartment Purpose Built Flat Show House Town House Other Unspec. Private Dwelling How many floors does the property have: - Please Select - 1 2 3 4 5+ Number of bedrooms: - Please Select - 1 2 3 4 5 6 7+ What is the property primarily constructed of: - Please Select - Asbestos Brick Brick/Timber Cob Concrete Corgtd Iron Essex Fibreglass Flint Glass Metal Plastic PreFab-Combust PreFab-NonComb Standard Stone Stramit Timber Frame Timber/Plaster Timbered Woodwall Woodwork Do you have a security system: - Please Select - Yes No