Name:*
Contact Tel:*
Address of Property:*
Date of Birth:
Building Sums Insured:*
Contents Sums Insured:*
Items covered outside of home?* Yes No
Alarm?* Yes No
Smoke Detectors?* Yes No
Locks on Windows/ Doors?* Yes both
Windows Only
Doors Only
None
Any Claims in the past 5 years?* Yes No
Please provide details of Claims:
What type of property is it:*
Owner Occupied Rented Property Holiday Home
Email:
Other Information:
 
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