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About
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Vacant Property Insurance Quote Form
Title
Mr
Mrs
Miss
Ms
First Name(s)
Last Name
Proposers date of birth
Telephone Number
Mobile Number
Email
Correspondence postcode
Correspondence address
Proposers occupation
Risk Details
Date cover required from
Risk Postcode
Risk Address
How long has the property been unoccupied for?
90 Days or Less
91 Days to 1 Year
1 – 2 Years
2 – 3 Years
3 – 4 Years
4 – 5 Years
5 or More Years
What is the long term intention for the property?
To be let
To Be Sold
To be owner occupied
Property Type
Bungalow - Detached
Bungalow - Semi detached
Bungalow - Terrace
Chalet Bungalow - Detached
Chalet Bungalow - Semi detached
Chalet Bungalow - Terraced
Flat - Basement
Flat - First floor or above
Flat - Ground Floor
Flat/Maisonette - in/above business
House - Detached
House - Semi Detached
House - Terraced
Maisonette
Mansion
Mobile Home
Town House
Approx. Year Built
Number of Bedrooms
1
2
3
4
5
6
7
8
9
10+
Is the property a Listed Building?
No
Yes - Grade I
Yes - Grade II
Construction of Walls
Brick
Asbestos
Brick / Timber Frame
Cob Construction
Concrete
Corrugated Iron
Essex Construction
Fibreglass Construction
Flint
Glass
Metal
Plastic
Prefab - Combustible
Prefab - Non Combustible
Stone
Stramit Construction
Timber
Timber / Plaster
Wattle and Daub
Woodwall
Woodwork Construction
Not Listed - Other
Construction of Roof
Slate / Tile
Asbestos
Asphalt
Concrete
Corrugated Iron
Felt on Timber
Fibreglass
Glass
Metal
Plastic
Shingle
Slate
Stramit
Thatch - Fibre
Thatch - Reed
Tile
Timber
Turnerised
Woodwork Construction
Not Listed - Other
Any part of the roof flat?
No
Up to 25%
Up to 50%
Up to 75%
Up to 100%
Buildings sum insured (enter 0 if cover is not required for this section)
Contents sum insured (enter 0 if cover is not required for this section)
Claims
Does the Proposer Have a Household Policy at the Correspondence Address?
Yes
No
Number of Years Claim Free
0
1
2
3
4
5
6
7
8
9
10+
Please provide full details of any claims in the last 5 years
General
Is the property in a good state of repair?
Yes
No
Free from any signs or any history of subsidence/heave/landslip?
Yes
No
Has the proposer or joint proposer ever been refused insurance or had special terms imposed?
No
Yes
You or anyone living with you, been convicted or cautioned for any criminal offences?
No
Yes
Been declared bankrupt or have any CCJ’s?
No
Yes
Is property close to any trees (within 7m & over 5m high) , cliffs, quarries or rivers?
No
Yes
Are all external doors fitted with a 5 lever mortice lock?
Yes
No
Are all accessible windows fitted with key operated locks?
Yes
No
Is there are a working alarm fitted at the premises?
No
Yes
