Property Investments

Please complete all of the following fields.
**Denotes compulsory field

Name **

Contact Number **

Email Address **

Preferred contact method

Please select Phone Email

Are you a new or existing client?

Please select New Existing

If new, please advise how you got our name

Please select Websearch Recommendation Advertising Other

If existing, please enter your Client Reference if known

Do you currently have Residential Let insurance for this business?

Please select Yes No

If yes, what is the renewal date?

D: M: Y:

What is the current annual premium that you pay?

Risk address

Is the property unoccupied?

Please select Yes No

What is the type of property?

Please select House Flat Masionette

Does the property have a flat roof?

If yes, what percentage of the roof is flat (approximately)(%)

State the approximate build date of the property (e.g. 1930s)

State the tenant type (e.g. professional tenants)

Buildings

Contents (if applicable)

Loss of rent

Loss of rent indemnity period (months)

Please select 12 24 36

Have you had any claims under this type of policy in the past 3 years?

Please select Yes No

If yes, please specify the number

Please select 0 1 2 3 4 5 6 7 8 9 10

Have any of these claims been settled for more than £2,500 (approx)?

Please select Yes No

Please provide any further details relating to your application (e.g. advise how the premises are heated / has the property been affected by subsidence or has it been underpinned?)