Schemes
Company
Correspondence Details
Insured Name
Agent Name
Point of contact:
Title
Mr
Ms
Mrs
Miss
Dr
Rev
First Name
Last Name
Email
Telephone
Insurance renewal date
Correspondence Address
Address Line 1
Address Line 2
City
County
Postcode
Country
Premises Details
Number of Flats
Number of Houses
Number of Commercial Premises
Have the insured had any claims in the last 5 years?
Yes
No
Incident date
(approx.)
Cause
Settlement Amount
Add another claim
Premises Address
Address Line 1
Address Line 2
City
County
Postcode
Country
Property Details
Building Declared Value
£
.00
Number of Blocks
Number of Floors
Floor Construction
Timber
Concrete
Built of brick/stone with slate/tile roof
Yes
No
If flat roof, does it account for over 1/3 of roof area?
Yes
No
Year property first built (approx)
Is building Grade 1 listed?
Yes
No
Number of Lifts
Are any dwellings unoccupied or used as holiday homes?
Yes
No
Has the property ever suffered from subsidence or flood?
Yes
No
Current Insurer
Current Premium
£
.00
