Name

Address:

Postcode:

e-mail address:

Address of Property to be insured:

Postcode:

Amount to be insured: £ (this can include carpets, curtains and fixtures)
Contents Insurance Required: £
Cover to start from?
Type of Property
Date built or approx age:
House/Bungalow in single tenancy? Yes   No 
Bedsit property with shared facilities? Yes   No 
Shared house in multiple occupancy? Yes   No 
Purpose built flats? Yes   No 
Number of people sharing:
Total number of flats:
Wall construction: Stone Brick Timber Framed Other
Roof construction: Slate Tile Other
Is the property in good condition and will it be maintained as such with regular inspections to detect any defects? Yes   No 
Do you employ letting agents? Yes   No 
Is the property currently unoccupied? Yes   No 
if yes - why, for how long, and what security and other measures will be undertaken?

Is it currently undergoing major repairs/refurbishment? Yes   No 
If yes - give details:

Have you sustained any accidents, losses or claims in the last 5 years, whether insured or not? Yes*   No 
Does the property show any signs, of subsidence, landslip or heave? Yes*   No 
Is the property in an area subject to flooding? Yes*   No 
Do you want your policy to include Legal Expenses Cover? Yes  No 
Do you want your policy to include Rent Guarantee Cover? Yes  No 

*if yes please provide details in 'Additional Information' below.

In Respect of Potential Tenants - do you or your letting agent:

Interview applicants personally? Yes  No 
Accept DSS referrals? Yes  No 
Take up employment and financial references? Yes  No 
Offer student accommodation? Yes  No 
Offer short term holiday accommodation? Yes  No 
Accept housing benefit tenants? Yes  No 

Additional Information: