Useful Information

How to obtain a quotation

Please complete our 'On-line Proposal Form'

We offer the online proposal form below, which provides you with a faster way of obtaining a firm quotation.

Simply complete the form and click on the 'Submit' button at the bottom of the page. Your quote form will then be emailed to us automatically and we will contact you with a quotation.

1. About you
Your name (including title): *
Name to appear on the policy (if different to above):
Home number:
Mobile number:
Work number:
Fax number:
Email: *
Correspondence address: *
Address of the home to be insured (if different from above):
2. Your personal details

Please provide details of all people (including you) that are resident at the insured address:

Name	Date of birth	Relationship	Occupation

3. Security of your home

Has the home:

a. key operated locks on all ground floor & easily accessible windows? * Yes No
b. 5 lever mortice deadlocks on all external doors? (excluding communal doors in flats) * Yes No
c. key operated bolts to top & bottom of each patio door and/or french window? * Yes No
d. a burglar alarm installed? * Yes No
1. If yes, is it maintained under contract with an NSI or SSAIB accredited company? Yes No
2. What type is it? Bells only
  Central station
  Redcare
e. a safe installed? * Yes No
1. If yes, what type is it? Wall
  Under floor
  Freestanding
2. If it is a freestanding safe, is it bolted to the floor? Yes No
3. Please provide the make & model:
If you have ticked ‘No’ to questions a, b or c above, or have any additional security in place (e.g. CCTV, security gates, porter, grills etc) please provide full details in Section ‘11. Additional information’
4. Type of home
a. Approximately what year was the property built:
b. Is the home: Main home
Pied a Terre
Second home
Holiday home (for family/friends only)
Let to tenants (6 months or more)
Let to tenants (less than 6 months)
c. Is the home regularly left unattended: Overnight
Weekends
In excess of 60 days
5. About your home

Important information about the home to be insured:

a. Is it built of brick, stone or concrete & roofed with slate, tiles or concrete? * Yes No
b. Is it in a good state of repair? * Yes No
c. Since you purchased the home has it ever flooded? * Yes No
d. Did any search or enquiry made by you or your conveyancer identify the home as being in an area which is at risk of flooding or has suffered flooding in the last 25 years? * Yes No
e. Is it within 250 metres of a river, stream, tidal water or other water course? * Yes No
f. Is it showing signs of internal or external stepped or diagonal cracking? * Yes No
g. Is it currently being monitored for subsidence, landslip or heave? * Yes No
h. Did any survey, search or enquiry made by you or your conveyancer identify the home as having been monitored for subsidence, landslip or heave in the last 25 years? * Yes No
i. Has it suffered from subsidence, landslip or heave in the last 25 years? * Yes No
j. Is it within 50 metres of any property that have been the subject of an occurrence of subsidence, landslip or heave in the last 25 years? * Yes No
k. Is it used for any business or commercial activities? * Yes No
l. Are the grounds of the home open to the public, or is there any public right of way? * Yes No
m. Are you due to have any building works carried out on it? * Yes No
n. Is it thatched, or any part of the buildings thatched? * Yes No
o. Is it listed? If so, please advise which grade: *
p. Is it a flat? * Yes No
1. If so is it self contained with own lockable entrance & under your sole control? Yes No
2. Which floor is it on?
If you need to provide any further information on the above questions, then please use the space provided:
6. Amounts to be insured

Section One – Buildings (full cost of reconstruction)

a. Main home (including your garage): £
b. Outbuildings: £
Please provide the name of any mortgagee that requires you to note their interest:

Section Two – Contents (current cost as new)

a. General Contents: £
b. Outdoor Items (garden furniture,
ornaments & statues): £
c. Baggage & Personal Effects (see IMPORTANT NOTE below): £

IMPORTANT NOTE: Your baggage & personal effects are automatically covered when the combined sum insured for 'Section Two - Contents' & 'Section Five -Valuables, antiques & works of art' is £100,000 or more. If your sums insured are below £100,000 & you would like baggage & personal effects cover, please state the amount you require above.

Section Five – Valuables, antiques & works of art (current cost as new)

a. Wine Collection: £
b. Antique Furniture & Objets D'art: £
c. Clocks & Barometers: £
d. Book Collection: £
e. Porcelain, China & Glass: £
f. Gold, Silver, Gold & Silver Plated Items: £
g. Paintings & Drawings: £
h. Furs: £
i. Guns: £
j. Jewellery: £

If you have a home safe and do not require all of your jewellery covered outside of the safe at any one time, you can reduce your premium by specifying the maximum value of jewellery you require outside of your safe at any one time in k. below:

k. Jewellery (maximum out of your home
safe at any one time): £
l. Jewellery (covered in your bank/safe
deposit only): £
Please provide the name & address of the bank/safe deposit:
Please confirm the date of your last professional valuation (if applicable):
7. Excess
The minimum policy excess is £100. If you would like to reduce your premium by accepting an increased excess, please tick the level you require: £250
£500
£750
£1,000
8. Your claims history
Have you or any other person whose property is to be insured sustained any loss or damage during the last five years which would have been covered by this type of insurance had it been in force, whether or not a claim was paid? Yes No

If Yes, please provide details below:

Date of loss	Value of claim	Details of loss
	£
	£
	£

9. Your previous history
a. Name of current insurers:
b. Current premium (optional):
c. Date your current insurance expires:
d. Date you wish cover with us to commence:
e. Has any insurer declined to accept, cancelled, refused to continue or agreed to continue only on special terms any insurance for you or any other person to whom this insurance would apply? Yes No
f. Have you or any other person living with you ever been convicted of or charged with any offence (other than a motoring offence or any convictions which are spent under the Rehabilitation of Offenders Act 1974)? Yes No
g. Are you or any other person living with you on the Register of County Court Judgements? Yes No

If you have ticked ‘Yes’ to questions e, f or g above, please provide full details in Section ‘11. Additional information’

10. Declaration
DATA PROTECTION ACT 1998
Any information you have provided will be dealt with by us in compliance with the provisions of the Data Protection Act 1998. For the purpose of providing this insurance & handling of any claims, which may arise under it, Underwriters may need to transfer certain information, which you have provided to other parties. By signing this proposal you agree that such transfer(s) may be made.

DECLARATION
To the best of my/our knowledge & belief the information provided in connection with this proposal, whether in my own hand or not, is true & I/we have not withheld any material facts. I/we understand that non-disclosure or misrepresentation of a material fact may entitle Underwriters to void the insurance. A material fact is one likely to influence acceptance or assessment of this proposal by Underwriters: If you are in any doubt as to whether a fact is material or not you must disclose it in the space below (continue on a separate sheet if necessary)

This proposal & the information provided in connection therewith contain statements upon which Underwriters will rely on when deciding to accept this insurance and the terms on which it may be offered, including the amount of premium payable. Should a contract be concluded this proposal would form the basis of the insurance.
11. Additional information
If you need to provide any further information, then please use the space provided below:

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Broker at Lloyds