Choose our home insurance service to compare the cheapest insurance deals available for your home. Please fill in the form and we will get in touch with you as soon as possible.
How did you hear about us? —Please choose an option—Walk inLeafletOnline advertisementFacebook pageFamilyExisting customerOthersNot heard or recommended
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Title:* —Please choose an option—MrMrsMsMissDr (Male)Dr (Female)
First Name*
Surname*
Date of Birth*
House Number/Name*
Postcode*
First Line of Address*
Marital Status* —Please choose an option—SingleMarriedCivil PartnerCohabitingDivorcedSeparatedWidowed
Any Children Under 16?* —Please choose an option—YesNo
Employment Status* —Please choose an option—EmployedUnemployedSelf EmployedHouse personStudentRetiredNot employed due to disability/illness
If Employed/Self Employed, what is your occupation:
If Employed/Self Employed, what type of business:
Your Email*:
Your Mobile*:
Your Phone:
Please contact me via PhoneTextemail
Property Address*
Type of property* —Please choose an option—Semi DetachedDetachedTerracedEnd TerraceFlatBungalowTown HouseOther
Estimated year property built*
Post Code*
Number of living rooms*
Number of bedrooms*
Number of kitchens*
Number of bathrooms*
Are there any trees taller than 10m within 5m of the property:* —Please choose an option—YesNo
Approximate % of flat roof* —Please choose an option—NoneLess than 20%Less than 40%Less than 50%More than 50%
Do you own this property:* —Please choose an option—Yes (Mortgaged)Yes (Own outright)Renting (Council)Renting (Private)Housing Association
Who lives in the property:* —Please choose an option—UnoccupiedPolicyholder and FamilyPolicyholder and LodgersPolicyholder Only
How many years have they lived at the property:
How many adults live in the property:
How many children under the age of 18 live in the property:
When is the property usually occupied: —Please choose an option—Day and NightOnly NightOnly Day
For how many days in a row is the property left empty (e.g. holidays): —Please choose an option—Less Than 14Less Than 30Only NightMore Than 60 Days
Does anybody in the property smoke: YesNo
Is the property ever used for business use: YesNo
Does the property have an alarm: —Please choose an option—Yes Bells OnlyYes Maintained by NACOSS or NSI AnuallyNo
What lock is fitted to your main door: —Please choose an option—5 Lever Mortice DeadlockKey Operated multi Point LockRim LockOther Lock
What other lock is fitted to any other external doors: —Please choose an option—No Other External Doors5 Lever Mortice DeadlockKey Operated Multi Point LockRim LockOther Lock
Do all ground floor windows have key operated locks: —Please choose an option—YesNo
How many working smoke alarms are there in the property:
Rebuild value of the property:
How many years NCB do you have buildings insurance: —Please choose an option—Never Had Building Insurnce12345678More
Contents value of the property: (including fixtures, furniture, utensils):
Would you like accidental damage cover for buildings: YesNo
Any specific items worth over £1000: YesNo
Would you like cover away from home: YesNo
Would you like accidental damage cover for contents: YesNo
In the past 5 years, have you or anyone living at the property made any home insurance claims or suffered any losses or damage, whether insured or not: YesNo
How much was the claim for?
What type of claim was it? —Please choose an option—BuildingsContents
What date was the claim?
Has the claim been settled? YesNo
When would you like the cover to start:
Is built with brick walls?
Has no significant cracks on the external wall
Is more than 400 meters away from water
Has a roof made of slate or tile
Is not for sale
Has never shown signs of heave, landslip or subsidence
Is your main residence
Has not had underpinning or structural support
Is not currently undergoing building work
Has never suffered from flooding
Do you agree with the above assumptions? YesNo
Name of your last insurer:
Renewal quote from your insurer:
Any Additional Comments
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