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Home Insurance

Your Details...
First name *
Surname *
Address *
Postcode *
Telephone number *
Email address *
Date of Birth *
Occupation *
Martial Status *

About your home...
Accommodation *
Is the property unoccupied during the day? *
House type *
Construction *
If other, please give details (eg - thatched roof)
Year of construction *
Number of bedrooms *
Number of years claim free: *
Neighbourhood Watch Scheme Member? *
Five lever Mortice Deadlocks on ALL exterior doors? *
Alarm fitted? *
Is the Alarm NACOSS Approved?
Does the house have Smoke Alarm? *

Buildings
Type of Cover *
Sum Insured *
Present Insurer *
Claims Last Three Years *
If Yes, please give details

Contents
Type of Cover *
Sum Insured *
Present Insurer *
Claims Last Three Years *
If Yes, please give details
Maximum value of any one item *

All Risks This cover is for items taken outside the home. eg, jewellery, cameras etc. The following are optional although some policies will automatically include some of these options as standard.
Personal Effects (e.g. clothes)
Details and values of any individual items worth more than £500
Valuables
Photographic equipment
Credit cards
Money
Freezer contents
Legal expenses cover
Best quote so far
Which insurer was this quote from?:

Further information
How would you like us to contact you *
Date cover required *	(dd/mm/yyyy)

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