Vacant Property Insurance Quote Form

Title

First Name(s)

Last Name

Proposers date of birth

Telephone Number

Mobile Number

Correspondence postcode

Correspondence address

Proposers occupation

Risk Details

Date cover required from

Risk Postcode

Risk Address

How long has the property been unoccupied for?

What is the long term intention for the property?

Property Type

Approx. Year Built

Number of Bedrooms

Is the property a Listed Building?

Construction of Walls

Construction of Roof

Any part of the roof flat?

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?

Number of Years Claim Free

Please provide full details of any claims in the last 5 years

General

Is the property in a good state of repair?

Free from any signs or any history of subsidence/heave/landslip?

Has the proposer or joint proposer ever been refused insurance or had special terms imposed?

You or anyone living with you, been convicted or cautioned for any criminal offences?

Been declared bankrupt or have any CCJ’s?

Is property close to any trees (within 7m & over 5m high) , cliffs, quarries or rivers?

Are all external doors fitted with a 5 lever mortice lock?

Are all accessible windows fitted with key operated locks?

Is there are a working alarm fitted at the premises?

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