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Home details

Renewal dates

Surgery Insurance Renewal Date
Locum Insurance Renewal Date
Home Insurance Renewal Date
Professional indemity Renewal Date

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All information submitted via this enquiry form is covered by the Data Protection Act 1998

Date of Birth
Is it a joint policy?	Yes No
Type of Property	Detached Semi-Detached Terraced End terrace Bungalow Flat Other
Approx date property was built
Bedrooms
Building construction
Roof construction
Does your property have any flat roof?	Yes No
Is your property listed?	No Grade I or equivalent Grade II or equivalent
Are all external doors fitted with 5 lever mortice deadlocks?	Yes No
Are there any sliding patio doors or French doors at the property?	Yes No
Property alarm type?	None Bells Digital Communicator Redcare
Is the property free from signs of flooding, subsidence, cracking, landslip or heave?	Yes No
Have there been any claims in the last 5 years? (If 'yes' please provide details of date, amount and reason.)	Yes No
Claims Details
Buildings Sum Insured £
Outbuildings Sum Insured £
General Contents Sum Insured £
Jewellery, Valuables & Antiques £
Jewellery, Valuables & Antiques over £5,000 £
Personal Possessions £ (items taken out or worn away from the home)
Fine Art & Paintings £
Do you have a safe? (If 'yes' please state type)	Yes No
Details
Renewal date
Renewal Premium
Current provider

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