Household Quotation Form
Customer name:
Email:
Telephone:
Risk address:
Current renewal date:
/
/
(dd/mm/yy)
Current premium:
Type of property:
Construction of property:
Walls
Roof
Year property built:
Number of bedrooms:
Number of claim free years:
Years resident in property:
Number of people in the property:
Over 18
Under 18
Buildings sum insured:
£
including
excluding
A/D cover
Contents sum insured:
£
including
excluding
A/D cover
Occupation and type of business:
Marital Status:
Date of birth:
/
/
(dd/mm/yy)
Additional info:
A/D
represents accidental damage cover
Please be realistic when calculating the sums insured as you can make big savings by not over insuring.
Image Verification Code: