Name *

Preferred telephone number *

How would you prefer to be contacted?

What day and time is best to contact you?

Date cover required

Risk address

Is the property occupied?

Type of property

How many bedrooms

Construction of walls

Construction of roof

Is there a flat roof?

What percentage of the roof is flat?

When was the property built?

How long has the property been unoccupied for?

Is the property a listed building?

Is the property in a good state?

Any refurbishments planned?

Is the property free from subsidence?

Is the property within 400m of a watercourse excavation?

Is the property in an area that has previously flooded?

Has the property ever been subject to an increased premium and/or terms – or cover declined?

Building sum insurance?

If you answered other amount, please give details.

How did you hear about us?

If you answered other, please let us know how you heard about our services.

Thank you for your enquiry.
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