By providing your details you are giving consent for us to contact you. The details you provide will only be used to contact you by telephone, email or post regarding your mortgage / protection requirements

We have made the following assumptions about you and anyone living with you: • You do not have any pending or unspent criminal convictions (excluding minor motoring offences) • You have not had any insurance cancelled, declined, declared void or had special terms applied • We have made the following assumptions about your property and it's outbuildings: • It is your main residence and lived in by you and your family, along with lodgers and occasional paying guests • It is self-contained with its own front door • It is not used for any business purpose other than childminding, paperwork, computer work or telephone calls • It is normally occupied at night or during the day and not left unoccupied for more than 60 days in a row It has not been affected by subsidence, heave, landslip or structural movement in the last 15 years It has not been underpinned, or provided with other structural support in the last 15 years • The walls are built of brick, stone, concrete or engineered timber (for properties built after 1960). • The roof is made of slate, tile, concrete or asphalt • It is not a Grade 1 or Grade A listed building It is in a good state of structural repair • Are all of these assumptions true? We have made the following assumptions about you and anyone living with you: • You do not have any pending or unspent criminal convictions (excluding minor motoring offences) • You have not had any insurance cancelled, declined, declared void or had special terms applied • We have made the following assumptions about your property and it's outbuildings: • It is your main residence and lived in by you and your family, along with lodgers and occasional paying guests • It is self-contained with its own front door • It is not used for any business purpose other than childminding, paperwork, computer work or telephone calls • It is normally occupied at night or during the day and not left unoccupied for more than 60 days in a row It has not been affected by subsidence, heave, landslip or structural movement in the last 15 years It has not been underpinned, or provided with other structural support in the last 15 years • The walls are built of brick, stone, concrete or engineered timber (for properties built after 1960). • The roof is made of slate, tile, concrete or asphalt • It is not a Grade 1 or Grade A listed building It is in a good state of structural repair • Are all of these assumptions true? Yes No

Do you need cover for damage caused by an accident in your home? Do you need cover for damage caused by an accident in your home? Yes No

Do you need cover for call-out fees, labour and materials to make your home safe after an emergency? Do you need cover for call-out fees, labour and materials to make your home safe after an emergency? Yes No

Do you need up to £50000 cover for you or your family to pursue or defend certain legal actions? Do you need up to £50000 cover for you or your family to pursue or defend certain legal actions? Yes No

Do you need to add cover for items worth less than £5000 that you can carry when you're away from home, like your mobile phone? Do you need to add cover for items worth less than £5000 that you can carry when you're away from home, like your mobile phone? Yes No

Do you need to add cover for valuable possessions worth over £5000 like watches and jewellery, in and away from the home? Do you need to add cover for valuable possessions worth over £5000 like watches and jewellery, in and away from the home? Yes No

Do you need to add cover for bicycles in and away from the home? Do you need to add cover for bicycles in and away from the home? Yes No

Choose Your Excess - This is the amount you are prepared to pay in the event of a claim. Choose Your Excess - This is the amount you are prepared to pay in the event of a claim. £100 £200 £300 £500

Address of property to be insured

What cover do you require? What cover do you require? Buildings & Contents Only Buildings Only Contents

Title

First name

Last name

Date of birth

Email

Mobile number

Is there a 2nd Applicant? Is there a 2nd Applicant? Yes No

2nd Applicant Title

2nd Applicant First Name

2nd Applicant Last Name

2nd Applicant Date of Birth

2nd Applicant Email Address

2nd Applicant Mobile Number

Previous claims Previous claims None One Two Three Four Five

Was it Building’s or Contents (Claim 1) Was it Building’s or Contents (Claim 1) Building's Content

Date of claim (Claim 1)

Approximately how much was the claim £ (Claim 1)

Claim Cause (Claim 1) Claim Cause (Claim 1)Freeze/Burst PipesEscape Of WaterFloodStorm DamageLightningMalicious DamageTheftFire/SmokeSubsidence, heave or landslipExplosionLiabilityAccidental DamageAccidental LossFreezer ContentsRemoval/TransitBreaking/Collapse Of AerialsCollision - Aircraft/Vehicles/LivestockEscape Of OilFalling TreesEarthquakeRiot/Civil CommotionUnderground Service PipeDrains and Underground Tanks

Did the claim occur at the address to be insured? (Claim 1) Did the claim occur at the address to be insured? (Claim 1) Yes No

Was it Building’s or Contents (Claim 2) Was it Building’s or Contents (Claim 2) Building's Content

Date of claim (Claim 2)

Approximately how much was the claim £ (Claim 2)

Claim Cause (Claim 2) Claim Cause (Claim 2)Freeze/Burst PipesEscape Of WaterFloodStorm DamageLightningMalicious DamageTheftFire/SmokeSubsidence, heave or landslipExplosionLiabilityAccidental DamageAccidental LossFreezer ContentsRemoval/TransitBreaking/Collapse Of AerialsCollision - Aircraft/Vehicles/LivestockEscape Of OilFalling TreesEarthquakeRiot/Civil CommotionUnderground Service PipeDrains and Underground Tanks

Did the claim occur at the address to be insured? (Claim 2) Did the claim occur at the address to be insured? (Claim 2) Yes No

Was it Building’s or Contents (Claim 3) Was it Building’s or Contents (Claim 3) Building's Content

Date of claim (Claim 3)

Claim Cause (Claim 3) Claim Cause (Claim 3)Freeze/Burst PipesEscape Of WaterFloodStorm DamageLightningMalicious DamageTheftFire/SmokeSubsidence, heave or landslipExplosionLiabilityAccidental DamageAccidental LossFreezer ContentsRemoval/TransitBreaking/Collapse Of AerialsCollision - Aircraft/Vehicles/LivestockEscape Of OilFalling TreesEarthquakeRiot/Civil CommotionUnderground Service PipeDrains and Underground Tanks

Did the claim occur at the address to be insured? (Claim 3) Did the claim occur at the address to be insured? (Claim 3) Yes No

Approximately how much was the claim £ (Claim 3)

Was it Building’s or Contents (Claim 4) Was it Building’s or Contents (Claim 4) Building's Content

Date of claim (Claim 4)

Claim Cause (Claim 4) Claim Cause (Claim 4)Freeze/Burst PipesEscape Of WaterFloodStorm DamageLightningMalicious DamageTheftFire/SmokeSubsidence, heave or landslipExplosionLiabilityAccidental DamageAccidental LossFreezer ContentsRemoval/TransitBreaking/Collapse Of AerialsCollision - Aircraft/Vehicles/LivestockEscape Of OilFalling TreesEarthquakeRiot/Civil CommotionUnderground Service PipeDrains and Underground Tanks

Did the claim occur at the address to be insured? (Claim 4) Did the claim occur at the address to be insured? (Claim 4) Yes No

Approximately how much was the claim £ (Claim 4)

Was it Building’s or Contents (Claim 5) Was it Building’s or Contents (Claim 5) Building's Content

Date of claim (Claim 5)

Claim Cause (Claim 5) Claim Cause (Claim 5)Freeze/Burst PipesEscape Of WaterFloodStorm DamageLightningMalicious DamageTheftFire/SmokeSubsidence, heave or landslipExplosionLiabilityAccidental DamageAccidental LossFreezer ContentsRemoval/TransitBreaking/Collapse Of AerialsCollision - Aircraft/Vehicles/LivestockEscape Of OilFalling TreesEarthquakeRiot/Civil CommotionUnderground Service PipeDrains and Underground Tanks

Did the claim occur at the address to be insured? (Claim 5) Did the claim occur at the address to be insured? (Claim 5) Yes No

Approximately how much was the claim £ (Claim 5)

Your Message