Landlord insurance quotation form

Landlord Insurance quotation form

Proposer details

Proposer forename *

Proposer last name *

Company name (if applicable)

Number of properties to be insured *

Is the proposer a UK resident? *

Policy Inception Date *

Email *

Correspondence address

Street + house nr. *

Town *

County *

Zip Code *

Personal History

Has the proposer or any director or partner: (in the business or any other name under which they have been trading)

Suffered any loss or incurred any liability, whether insured or not, during the last 3 years as a result of the risks proposed (whether at this or any other premises) or had any claims made against you? *

Been convicted of or in the course of being charged with any cirminal offence (excluding driving offences and spent convictions)? *

Been declared bankrupt or been a director of any company that went into liquidation? *

Ever had any insurance declined, refused or cancelled by an insurer? *

Employers liability

Is Employers Liability cover required? *

Property, cover, occupancy details

Property details

Risk postcode *

Risk Address + house nr. *

Risk town *

Risk county

Year of build *

Is the property a listed building? *

Cover required

Buildings Sum Insured (£) *

Is Accidental Damage Cover Required for Buildings? *

Contents Sum Insured (£) *

Is Accidental Damage Cover Required for Contents? *

Occupancy Details

Type of occupancy *

Number of tenants *

State maximum in any one unit/property

Lease agreement is between Freeholder or their Agent and: *

Duration of lease agreement: *

Does the lease allow your tenant to sub-let? *

Are the current tenants in rent arrears and/or subject to eviction proceedings? *

Will cooking be allowed in an area other than a clearly designated kitchen or an area that complies with the Regulatory Reform (Fire Safety) Order 2005? *

Property Construction

Property type *

Total number of flats/units in property

Total number of flats/units to be insured

Floor construction * Floor construction

Is property more than 4 floors high? *

Is any part of the property flat roofed? *

Is the building in a good state of repair? *

This means that is is secure, structurally sound, weatherproof, there is no evidence of dry rot, rising damp or infestation and there is no damage to the roof or chimney.

Is the property heated solely by electricity, and/or mains gas, and/or solid fuel and/or oil fired central heating? *

Is the property built solely with: Brick (including timer frame), stone, or concrete (not prefabricated) walls OR: Slate, tile or concrete roof (other than flat roof sections)? *

The Premises

Has the property ever been flooded an/or located within 10 metres of the sea, river, watercourse, lake, reservoir, canal or dam? *

Is the property within 100 metres of a cliff, quarry or other excavation? *

Is the property having any structural alterations, or major renovation work affecting load bearing walls or the roof, or any such works being planned? *

Is the property currently having any other building wok undertaken, or planned within the next 12 months, that will cost more than £25,000 (including redecoration)? *

Has the property experienced any existing or previous stepped/diagonal cracking, subsidence/ground heave/landslip, movement or underpinning? *

Are any party of the premises ever used as a second home, holuday let or any commercial business whether to be insured on this policy or not? *

Would you like the option to quote Legal Expenses?

This cover is optional and may be included or excluded at quotation stage.

Material Facts Declaration

Do you need to provide any other Material Facts in relation to this proposal form or property? *

Please provide details

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Additional Proposers

Is this a joint proposal? *

Additional proposer name

Additional proposer Address

Additional proposer Relation to main proposer

Interested Parties

Note of interest (if applicable)