As quotes can only be accurate at the time of issue please tell us the renewal date of your existing policy. Your application will be acknowledged and the quotation sent ahead of your renewal date.
Renewal Date of Existing Insurance: or Immediate Cover Required: Yes No
In addition to our quotation, do you wish to have a quotation from any particular insurer such as Commercial Union, General Accident, Guardian, Lloyds or Norwich Union? If so, please specify:
e-mail address: First name: Last name: Title: Address: Post Code: Home Phone Number: Work Phone Number: Fax Number: Proposer Age: years Smoker: Yes No Occupation: Employed: Yes No Sum Insured: Contents: ú Building: ú Personal Belongings: ú Basis for Cover for Contents: Standard Other Basis for Cover for Buildings: Standard Other Type of Dwelling: Flat House Number of Bedrooms: Age of property: Standard Construction: Yes No If No then what? Claims History (previous 5 years'): Burglar Alarm: Neighbourhood Watch: First Home