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Please complete all the fields marked with an
*
Your Personal Details
Title
*
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Mr
Mrs
Miss
Ms
Dr
First Name
*
Surname
*
Date of Birth
*
(dd/mm/yyyy)
Email
*
(e.g. yourname@host.co.uk)
Please Confirm Email
*
Telephone
*
Mobile
Employment Status
*
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Retired
Employed
Self Employed
Unemployed
Insurance Information
Years of Continuous Cover
*
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0
1
2
3
4
5
6
7
8
9
9+
Commencement Date of Cover
(dd/mm/yyyy)
How many claims have you made in the last 5 years?
-- select --
none
1
2
3
4
5+
Postcode
*
Type of Cover
Type of Cover
*
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Contents cover
Buildings and Contents
Buildings cover
Contents Cover
Amount to Insure
*
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0 to £50,000
£51,000 to £100,000
£101,000 to £150,000
£151,000 to £200,000
£201,000 to £250,000
£251,000 to £300,000
£300,000 +
(Contents)
Do you have any individual items that are worth over £5,000?
Item Summary
Type of Item
-- select --
Art
Antique
Collectable
Jewellery
Other
Item Description
Item Value
-- select --
£5,001 to £10,000
£10,001 to £20,000
£20,001 to £30,000
£30,001 to £40,000
£40,001 to £50,000
£50,001 to £100,000
£100,001 to £150,000
£150,001 +
Buildings Cover
Amount to Insure
*
-- select --
0 to £500,000
£501,000 to £700,000
£701,000 to £900,000
£901,000 to £1,100,000
£1,101,000 to £1,300,000
£1,301,000 to £1,500,000
£1,501,000 +
(Buildings)
Type of Property
*
-- select --
Basement Flat Conversion
Basement Purpose Built Flat
Chalet
Detached Bungalow
Detached House
Detached Maisonette
End Of Terrace Maisonette
End Terraced Bungalow
End Terraced House
Flats (Conversion To Existing Dwelling
Ground Floor Flat Conversion
Ground Floor Purpose Built Flat
Maisonette
Mansion
Mid Terrace Maisonette
Mid-Terraced Bungalow
Mid-Terraced House
Mobile Home
Other Floor Flat Conversion
Other Floor Purpose Built Flat
Purpose Built Flat
Rooms
Semi Detached Maisonette
Semi-Detached Bungalow
Semi-Detached House
Service Flat Within Employers Premises
Top Floor Flat Conversion
Top Floor Purpose Built Flat
Unknown
Unspecified Private Dwelling
Not Covered By Any Other Item On The List
How Many Bedrooms
*
-- select --
1
2
3
4
5
6
7
8
9+
Working with names you know
Key Benefits
Up to 30% no claims discount
Contents insurance cover available up to £500,000
Buildings insurance cover available up to £1,500,000
Full accidental loss and damage cover for buildings and contents
Worldwide cover for all of your possessions
New-for-old replacement of damaged items
Specified item cover available up to £200,000
Individual item cover up to £5,000
Business cover up to £15,000
Specialist UK based advisers