Friday, 24th May 2013
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Landlords Buildings / Contents Quotation Request Form
YOUR DETAILS
Your Full Name
Date of Birth (dd/mm/yyyy)
Occupation
Correspondence Address
Contact Telephone Number
Email Address
RISK DETAILS
Rental Property Address
Postcode
Year Property Purchased
Type of Property
Terrace House
Semi-Detached House
Detached House
Maisonette
Self-Contained Single Flat
Block of Flats
Semi-Detached Bungalow
Detached Bungalow
Type of Roof
Tiled / Slated
Tiled / Slated & up to 25% flat roof (asphalt on timber frame)
Tiled / Slated & up to 50% flat roof (asphalt on timber frame)
Tiled / Slated & up to 75% flat roof (asphalt on timber frame)
100% Flat roof (asphalt on timber frame)
100% Flat roof (concrete)
Aluminium
Iron or Steel
Thatched Roof
Other (please provide details within ‘Misc Info’)
Number of Bedrooms
Year Property was Built
Is it a Listed Building?
No
Yes – Grade 1 Listed
Yes – Grade 2 Listed
Any History of Flooding at the Property or Area
No
Yes (please provide details below)
Any History or Signs of Subsidence at the Property or Area
No
Yes (please provide details below)
Name of other Interested Party or Mortgage Company
COVER REQUIRED
Buildings Sum Insured
Do you Require Accidental Damage to Buildings
No
Yes
Do you Require Malicious Damage to Building by Tenant(s)
No
Yes
Do you Require Cover for Trace & Access
No
Yes
Landlords Contents Sum Insured
Do you Require Accidental Damage to Contents
No
Yes
Do you Require Malicious Damage to Contents by Tenant(s)
No
Yes
Do you Require Theft of Contents by Tenant(s)
No
Yes
Type of Tenant
Employed / Working
Retired
Students
DSS/Benefit Claiming (agreement between landord & tenant)
DSS/Benefit Claiming (agreement NOT between landord & tenant)
Date Cover Required (dd/mm/yyyy)
CLAIMS HISTORY
Details of ALL Property Claims Within Last 5 Years
ADDITIONAL INFORMATION
Additional Information
SPAM PREVENTION QUESTION
What color is snow?
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