All fields marked ” * ” are mandatory.Quote Form - Non agent 1 Client Details2 Property Details3 Security Details4 Sums Insured5 Policy Excess6 Other InformationContact Name:*Telephone:Email:* Date of Birth:*Occupation:*Contact Name (Second proposer):*Date of Birth (Second proposer):*Occupation (Second proposer):*Address of property to be insured:Postcode:*Type of property (please Check):* Terrace Semi-Detached Detached Bungalow Flat Barn Conversion Park HomeOccupancy (please Check):* Main Residence Professional Let Holiday Let Holiday Home UnoccupiedWorking from home?*Please SelectYesNoPlease SelectPlease state the nature of the work carried out at the property:*Has the property any history of subsidence, heave, landslip, flooding, or major fire?Please selectYesNoIf yes, please provide details:*Building construction:*Roof construction:*Year of construction:*Listed?*Please SelectYesNoPercentage thatch (%):*Please enter a number from 0 to 100.Type of Thatch:*Type of heating at the property (Tick all that apply):* AGA Electric AGA Solid Fuel Gas Central Heating Multi Fuel Oil Fired Central Heating Open Fire Solid Fuel Solid Fuel Central Heating Storage Heaters Wood BurnerAre chimneys/ flues lined?*Please selectYesNoDoes the property have a 60 minute fire barrier?*Please SelectYesNoDoes the property have smoke detectors?*YesPlease selectNoIs an up-to-date electrical installation certificate available?*YesPlease selectNoIs the property in a neighbourhood watch area?*YesPlease selectNoIs the property fitted with 5 lever mortice deadlocks and key operared window locks?*YesPlease selectNoIf No, please give details:Is there a NACOSS/ SSAIB alarm?*YesPlease selectNoIf Yes, please state type:Is the alarm covered by an annual maintenance agreement?*YesPlease selectNoIs there a safe?YesPlease selectNoIf Yes, please give details:*Main building (£):Outbuildings (£):Total building sum insured (£):Is accidental damage cover required (Buildings section)?YesNoGeneral contents (£):Outdoor Items (£):Gold, SIlver & plate (£):Redundant Jewellery, watches & other valuables never worn or taken outside the home (£):Stamp & coin collections (£):Fine art and antiques (£):Total contents sum insured (£):Is accidental damage cover required (Contents section)?YesNoUnspecified All Risks (SAL £2,500):Specified All Risks:Pedal Cycles (up to £500 total):Specified cycles over £500:Please note that there is a compulsory policy excess of £100 on main residences and £250 on all others.Voluntary excess in addition, Contents (please check): £100 £250 £500 £1,000Voluntary excess in addition, Buildings (please check): £100 £250 £500 £1,000Any Claims in the last 5 years?*YesPlease selectNoAre you planning any building works?*YesPlease selectNoHas insurance ever been declined?*YesPlease selectNoAny convictions?*YesPlease selectNoEver been declared bankrupt?*YesPlease selectNoIf Yes to any of the above, please provide details:Current insurer:Target Premium (£):Renewal Date: DD MM YYYYAny other information?:Where did you hear about us?:* County Show Bus stop Advertisement Cotswold Homes Advertisement Existing client Referral Internet search Facebook LinkedIn Twitter Other Previous ClientΔ