Home Insurance Application — get a quote

Date Quotation Required From:

Personal Info

Title:
Forenames:
Surname:
Gender:
Date of Birth:: You must be 25 or over
Place of Birth:
When did you become an IOM/UK resident:
Marital Status:
Occupation:
Employers Business Type:
Contact Tel Number(s):
Email Address:: If you provide a contact email address we will email you confirmation when you submit this form
How did you hear about us:

Your Property

Address:
Post Code:
Property Type:
Approx. age of building:
Type of construction:
If not standard, please give details:
Any building work in progress?
If yes, please give details:
Number of bedrooms:
Is it a holiday home?
Is it owned or rented?
Are you a first time buyer?
Is it let or sub-let?
Is it used for business?
If yes, describe nature of business:
Are all windows fitted with key operated locks?
Do you have an alarm installed?
Are smoke detectors installed?
Is the building in a good state of repair?

Previously…

Has the building ever been flooded?
Is the building in a flood area?
If yes, please give details:
Have you previously had buildings insurance?
If yes, who was your insurer:
Have you previously had contents insurance?
If yes, who was your insurer:

Years since your last claim:
How many claims in the last five years:: Fill in any details below.

Claim 1

Details of the claim:
Date of claim:
Amount of payment received:

Claim 2

Details of the claim:
Date of claim:
Amount of payment received:

Claim 3

Details of the claim:
Date of claim:
Amount of payment received:

Cover Details

Do you require buildings cover?
If yes, specify rebuild cost:
Do you require contents cover?
If yes, specify replacement value:
Any cycles over £750?
If yes, please provide details & value:
Have you any items of Jewellery/watches/laptops over £2,000 individual value?
If yes, please provide a description & value of each item:
Do you require hearing aid cover?
If yes, please provide details and value:

Do you have an alternate address for correspondence?

Correspondence Address

Address:
Post Code:

I confirm that all persons named including myself have no criminal convictions or have ever been refused insurance:

Legal Agreements

You understand and agree to the information being submitted:: You must confirm that you have understood and agree to the information supplied on this form.
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