Household Quotation Form

Please provide the following information:

 

Name
Title
Street Address
Address (cont.)
City
County
Post Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

 

Date of Birth
Sex	Male Female

Occupation.

Renewal Date

-- dd/mm/yy

Current Insurer

Current Renewal Premium

 

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Main Buildings

 

Main Buildings Sum Insured

Outbuildings Sum Insured

Type of Construction

Standard
Thatched
Timber Framed
Flat
Other

If other, please specify

Is the property free from Subsidence?

Yes
No

If No, please provide full details

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General Contents

General Contents Sum Insured

Outdoor Items Sum Insured

Fine Art / Antiques

 

 

Pictures, Paintings, Sketches, Prints and the like

Books

Statues and Sculptures of a non-fragile nature

Antique Furniture

Items of a brittle or fragile nature

Clocks, Watches and other mechanical art

Gold, Silver and other precious metals

Guns

Wine Collection

Other Items

Valuables

Jewellery and Watches

Jewellery in Safe only

Jewellery in Bank or Safe Deposit

Furs

Other Valuables

Voluntary Excess

£500
£1000

Have you suffered any claims in the past six years?

Yes
No

If yes, please provide details

Do you have an alarm system installed?

Yes
No

If yes, please select the type of alarm

Bells Only
Central Station
Redcare

Do you own a safe?

Yes
No

If yes, please provide the make and model

Has an inventory valuation been commissioned in the last 5 years?

Yes
No

If yes, please provide the date the valuation was completed and the valuer