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 one Yes No 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 one Yes No Been convicted of or in the course of being charged with any cirminal offence (excluding driving offences and spent convictions)? * Choose one Yes No Been declared bankrupt or been a director of any company that went into liquidation? * Choose one Yes No Ever had any insurance declined, refused or cancelled by an insurer? * Choose one Yes No Employers liability Is Employers Liability cover required? * Choose one Yes No 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 one Yes No Cover required Buildings Sum Insured (£) * Is Accidental Damage Cover Required for Buildings? * Choose one Yes No Contents Sum Insured (£) * Is Accidental Damage Cover Required for Contents? * Choose one Yes No 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 one Yes No Are the current tenants in rent arrears and/or subject to eviction proceedings? * Choose one Yes No 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 one Yes No Property Construction Property type * Total number of flats/units in property Total number of flats/units to be insured Floor construction * Choose one Timber Concrete Mixed Other Floor construction Is property more than 4 floors high? * Choose one Yes No Is any part of the property flat roofed? * Choose one Yes No Is the building in a good state of repair? * Choose one Yes No 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 one Yes No 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 one Yes No 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 one Yes No Is the property within 100 metres of a cliff, quarry or other excavation? * Choose one Yes No 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 one Yes No 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 one Yes No Has the property experienced any existing or previous stepped/diagonal cracking, subsidence/ground heave/landslip, movement or underpinning? * Choose one Yes No 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 one Yes No Would you like the option to quote Legal Expenses? Choose one Yes No 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 one Yes No Please provide details Add additional property Remove property Additional Proposers Is this a joint proposal? * Choose one Yes No Additional proposer name Additional proposer Address Additional proposer Relation to main proposer Interested Parties Note of interest (if applicable) Continue to summary
