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Home Insurance Quote Form
THE PROPOSER
*required
*Title:
*Occupation:   (the term Company Director is not sufficient)
*Forenames:
*Your surname:
*Address:
*Postcode:
Date of birth:
Day Month Year (e.g. 1980)
*Tel no.
*Email address:

Address of property to be insured:
(if different to previous)
Postcode of property to be insured::
(if different to previous)

If the home is permanently occupied tick box for additional discount: Yes    No
Period of insurance required from:   Select Date
 

THE PROPERTY AND SECURITY
Current insurers: (if none please give reason)
Approximate year the house was built:
Details of alarm: (if applicable)
Was the alarm installed by NACOSS/SSAIB approved installer? Yes    No
Is it NACOSS/SSAIB maintained? Yes    No
Make and model of safe: (if applicable) Make    Model
   

REQUIRED SUMS INSURED:   Sums insured
a) Buildings
As stated at the above address
(i) Main residence:  
(ii) Outbuildings:
Statues and garden ornaments and outdoor 		£  
(iii) Statues and garden ornaments and outdoor items: £  
(iv) Other items: (please give details) £
   
b) Contents
(i) General contents:  
(ii) Fine art and antiques including; paintings, drawings, antique furniture, books and manuscripts, statues and
sculptures, stamp and coin collections, porcelain, glass, pottery, clocks, barometers, mechanical instruments
and antique guns:		 £  
(iii) Items of gold, silver, gold or silver plate and other precious metals: £  
(iv) Other items: (please give details) £
(v) Any items {i.e. in addition to (ii) - (iv) above} kept in a bank vault/depository and only removed for up to 30 days during the period of insurance: £  
Name and address of bank vault/depository:
Postcode:
   
c) Personal possessions
(i) Personal possessions including: jewellery, pearls, gemstones, watches, furs, guns, pedal cycles, tack, saddles and rugs:  
What value given in (i) above relates soleley to jewellery, pearls, gemstones and watches? £  
(ii) Any items {i.e. in addition to (i) above}
kept in a bank vault/depository named above in part b (v) and only removed for up to 30 days during the period of insurance:		 £  
(iii) Money (maximum sum insured £2500): £  
(iv) Credit cards (maximum sum insured £5000): £  
(v) Other items: (please give details) £ Details
(vi) Any items {in addition to (i) and (ii) above}
PERMANENTLY kept in a locked safe within the home:		 £    
   

REQUIRED DEDUCTIBLES:
Please indicate which deductible the proposer requires:
   

Property Construction & Security:
(i)  The property is of standard construction, built of brick, stone or concrete and is in good state of repair.
(ii) The property is in an area free from flooding and normally free from subsidence, heave, landslide or coastal river erosion. The property is free from signs of damage due to subsidence, heave or landslide (and is not being monitored), for subsidence, heave or landslide. The property has not been the subject of a survey which mentions settlement or movement of buildings
(If you cannot confirm this please provide full details below and enclose a copy of the survey with this proposal form).
(iii) The property is not used in connection with any business or profession and is not let out, and is not regularly unattended throughout the day or night
(iv) All external doors are fitted with 5 lever mortice deadlocks and all ground floor windows, fanlights, skylights and patio doors have key operated locks
(v) Where the total Contents, Fine art and antiques exceeds £50,000, in total value, there is an alarm system in operation which is regularly used and that an alarm maintenance agreement is in force.
(vi) Where total jewellery, pearls, watches etc., exceeds £25,000 in total value, there is a premises safe or strongroom in use.
(vii) All insured items of Contents, Fine Art, gold, silver plate with a single item value in excess of £15,000 have been listed separately and enclosed with this proposal form, giving the description and value of each item. The Proposer understands that in some cases, an
independent valuation or appraisal may be required.
(vii) All insured items of Personal Possessions with a single value in excess of £5,000 have been listed and enclosed with this form giving the description and value of each item. The Proposer understands the in
some cases, an independent valuation or appraisal may be required.
(ix) The Sums Insured requested under Part A Buildings represent the current replacement cost of the property.
(x) The Sums Insured requested under Part B Contents represent the current replacement cost of the Contents.
(xi) Neither the Proposer, nor any member of his family living with him has been refused insurance or had any special terms and conditions imposed: been convicted for or has prosecutions pending for any criminal acts (other than motor offences).
(xii) Neither the Proposer, nor any member of his family living with him has made a claim within the last 5 years or has a claim pending against them.
 
If you are unable to confirm any of the statements (i) to (xii) under Property Construction and Security at the above, please provide details.
(Include any claims within the last 5 years i.e. dates, circumstances & payments made, and details of non standard construction).


  Terms of Business    
© 2008 H R Jennings & Co Limited are authorised and regulated by the Financial Services Authority
Registered address: 21 Buckle Street, London E1 8NN