Home HHI Quotation Request Form
Title *
Full Name*
Date of Birth
Occupation
Home Telephone
Mobile Telephone
Email Address
Is this policy to be in joint names? yesno
Full name*
Have you, or anyone residing with you, ever had any insurance cancelled or special terms imposed? yesno
Have you, or anyone residing with you, ever had county court judgements or been declared Bankrupt (even if now discharged)? yesno
Have you, or anyone residing with you, ever had any Criminal Convictions, other than for motoring? yesno
What is the Address of the property that is to be insured?
What is the post code of the property?
How long have you lived at this address?
What year was the property built?
If you’ve lived here less than 5 years, please put your previous address below
What type of building is this property, e.g. detached
Wall Construction
Is the property timber framed? YesNo
What is the infil?
Roof Construction
Flat roof %
How many bedrooms?
How many bathrooms?
Has the property got a basement? YesNo
Are there any refurbishments planned? YesNo
Is the property in a good state of repair? YesNo
Is the property used as a holiday home? YesNo
Is the property vacant for more than 60 days? YesNo
Is the property let? YesNo
Type of tenant
Is the property on mains water YesNo
Is the property on mains sewer YesNo
Heating Fuel Type
Distance from nearest fire station (miles)
Full or part time
Does the property show any signs of, or are you aware of, any previous or potential damage by subsidence, heave or landslip? YesNo
Is the property in an area susceptible to flooding, or has the property (or surrounding properties) to the best of your knowledge ever flooded? YesNo
Please state distance and height that the property(s) flooded
Has your property been underpinned? YesNo
Is the property used in connection with any business? YesNo
Is the property listed? YesNo
If so, what grade?
If you answered yes to the above, please provide additional information if relevant
Is the main entrance door fitted with a 5 level mortice deadlock or equivalent? YesNo
Are all accessible windows fitted with key operated locks? YesNo
Are patio doors or french doors fitted with key operated locks internally? YesNo
Audible (bells only)? YesNo
Linked to a recieving centre? YesNo
BT Redcare? YesNo
Maintenance contract in force? YesNo
More than 2 false alarms in the last 12 months? YesNo
NACOSS or SSAIB Approved? YesNo
Audible Only? YesNo
How many smoke detectors do you have?
Are they battery or hard wired? BatteryHard-Wired
Do you have a safe at the property? YesNo
Is the safe anchored to a wall or the floor?
What is the make and model of the safe, alongisde a cash limit if known
Security patrolled entrance 24 hours? YesNo
Security Lights? YesNo
Security Cameras? YesNo
Neighbourhood watch (member)? YesNo
Owned on mortgage YesNo
Owned Outright YesNo
Nature of interest
Name/Address/Role etc
Have you made any claims for buildings or contents in the last 5 years? YesNo
How much was the claim for?
What was the date of the claim
What was the reason for the claim?
Do you have any other claims made in the past 5 years? YesNo
Please use the box below for any additional information needed
Cover Required? YesNo
With accidental damages? YesNo
Buildings Sum Insured – Main property
Outbuildings – If not included above
Buildings excess required —Please choose an option—£100£250£500Other
How much?
Contents excess required —Please choose an option—£100£250£500Other
General Contents (Not including below)
Antique Furniture
Fine art/Pictures
Unspecified Jewellery
Gold, Silver, Plate
Coin Collections
Collectibles
Cameras
Guns
Book Collections
Rugs and Tapestries
Clocks and Barometers
Furs
Stamp Collections
Musical Instruments
Wine
Ride on Mowers
Business contents at home
Contents in garages/outbuildings
Contents in the garden
Unspecified personal belongings (All Risks)
Specified Jewellery
Are all of the fields, to your knowledge, accurate and complete? YesNo
Is there any additional information that you need to provide us with?
Please prove you are human by selecting the key.
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