UK:
Portugal:
Spain:
France:
Italy:
Bulgaria:
Greece:
Cyprus:

 

Please complete the sections below as comprehensively as possible in order that we can deliver the best service to you. It is important that any information you supply is complete and accurate as this is the basis upon which your quotation
will be based, failure to provide correct information could invalidate the cover or void a claim. Any information you provide will be verified throughout the
quotation process.

  
 


   
* Denote compulsory field
   
Proposer Details    
     

Salutation

   *
Forename
   *
Surname
   *
D.O.B
   *
Occupation
  

*

 
 
Contact Address    
     

Address 1

   *
Address 2
  *
Address 3
  *
Address 4
  

Country

   *

Postcode

  *

Tel

   *

Email

   *
   

 
Address to be insured
 

Address 1

  
Address 2
*
Address 3
*

Address 4

 

Country

   *

Postcode

  *

Tel

   *

Email

   *

 

    
Your Property 		   
   
Type of Property
 *
Property Format
*
Property Use
*
Who will use the Property *
Is the Property of Standard Construction
*
Year Built
 *
Is the Property Occupied more than 4 months at any one time
   *
   
Security
 
Alarm to Control center
 *
Alarm with bells
 *
Security Doors
 *
Mortice deadlocks on doors
*
Key operated window locks
 *
Key operated patio/sliding door locks
 *
Shutters
 *
Window Bars
*
     
Sums Insured
 
State currency for sums insured
  *
Building Sums Insured
   * (Rebuild value)
Do you wish to include Accidental Damage
  *
Contents Sum Insured
   *
Do you wish to include Accidental Damage
  *
Jewellery and valuables
   *
Do you wish to include Accidental Damage
  *
     
Claims/Losses    
 
 
Have you made any claims under previous insurance on this property
   *
   
If yes please provide details  
(dates, details, costs)
   
 
If No, how many years claim free
  *
 
General Details
 
 
Have you any criminal convictions
  *
   
If yes please give details  
   
     
 
Who is your existing provider
   *
Target premium
*
 
When do you want cover to start
   *
Where did you hear about us
*
   
    *Denote compulsory field