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? * Choose oneYesNo 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? * Choose oneYesNo Been convicted of or in the course of being charged with any cirminal offence (excluding driving offences and spent convictions)? * Choose oneYesNo Been declared bankrupt or been a director of any company that went into liquidation? * Choose oneYesNo Ever had any insurance declined, refused or cancelled by an insurer? * Choose oneYesNo Employers liability Is Employers Liability cover required? * Choose oneYesNo 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? * Choose oneYesNo Cover required Buildings Sum Insured (£) * Is Accidental Damage Cover Required for Buildings? * Choose oneYesNo Contents Sum Insured (£) * Is Accidental Damage Cover Required for Contents? * Choose oneYesNo Occupancy Details Type of occupancy * Number of tenants * State maximum in any one unit/property Please select ALL the types of tentant(s) occupying the property * Employed/Self Employed Retired Housing benefit recipient Student Asylum seeker Owner occupied Vacant Vacant to be sold Other:Other: Lease agreement is between Freeholder or their Agent and: * Duration of lease agreement: * Does the lease allow your tenant to sub-let? * Choose oneYesNo Are the current tenants in rent arrears and/or subject to eviction proceedings? * Choose oneYesNo 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? * Choose oneYesNo Property Construction Property type * Total number of flats/units in property Total number of flats/units to be insured Floor construction * Choose oneTimberConcreteMixedOther Floor construction Is property more than 4 floors high? * Choose oneYesNo Is any part of the property flat roofed? * Choose oneYesNo Is the building in a good state of repair? * Choose oneYesNo 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? * Choose oneYesNo 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)? * Choose oneYesNo The Premises Has the property ever been flooded an/or located within 10 metres of the sea, river, watercourse, lake, reservoir, canal or dam? * Choose oneYesNo Is the property within 100 metres of a cliff, quarry or other excavation? * Choose oneYesNo Is the property having any structural alterations, or major renovation work affecting load bearing walls or the roof, or any such works being planned? * Choose oneYesNo 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)? * Choose oneYesNo Has the property experienced any existing or previous stepped/diagonal cracking, subsidence/ground heave/landslip, movement or underpinning? * Choose oneYesNo 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? * Choose oneYesNo Would you like the option to quote Legal Expenses? Choose oneYesNo 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? * Choose oneYesNo Please provide details plus1 Add additional property minus1 Remove property Additional Proposers Is this a joint proposal? * Choose oneYesNo Additional proposer name Additional proposer Address Additional proposer Relation to main proposer Interested Parties Note of interest (if applicable) Continue to summary