Home Insurance Quote                0800 9774200

Please provide the following information:

Name
Date of Birth
1st line of YOUR Address
Postal Code
Phone no.
Mobile Phone no.
E-mail
1st line of Address to be insured
Postal Code of Address to be insured
Does the property have 5 lever locks on all external doors?	Yes No
Does the property have window locks?	Yes No
Is the property brick or stone with a slate or tile roof?	Yes No
Does the property have any flat roof area?	No up to 10% 10-25% 25-40% 40-50% more than 50%
Any previous buildings claims or uninsured losses?	No Yes
Any subsidence, heave or landslip history?	No Yes
Is the property near cliffs, quarries, mines or anything of that nature?	No Yes
Is the property within 200m (220yds) of any water?	No Yes
Are there any trees or large shrubs within 7m (20ft) of the property?	No Yes
Is the property Listed?	No Grade 1 Grade 2 Grade 3
Buildings Sum Insured £
Contents Sum Insured £

Is there anything else you want covered?