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1POLICY HOLDER DETAILS

2FURTHER DETAILS

3PROPERTY DETAILS

4COVER REQUIRED

5SEND REQUEST

Further Details

Date of Birth:*

Occupation:*

Trade/Business (please also specify the industry you work in)*

Employer:

Current Insurer (important)

If you are purchasing the property or have recently exchanged or completed please type in 'New purchase'

Your renewal premium (important)

If you are purchasing the property or have recently exchanged or completed please type in 'New purchase'

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Are you the owner of the property?*

Yes

Is it a Joint Policy?*

Yes

Joint Policy Holder Name:*

Title First Name Last Name

Date of Birth:*

Email Address*

Occupation:*

Trade/Business (please also specify the industry you work in)*

Employer:

Phone Number:*

ADDITIONAL INFORMATION

Have you had any claims in the last 6 years?*

Is the claim settled or still outstanding?*

Date of Claim*

Cause of Loss*

Please detail a description of the claim(s)

Cost of Claim*

in £

Please tell us any additional information about the claim(s)

Have there been any further claims in the last 6 years?*

Yes

Additional Claims

Is the additional claim settled or still outstanding?*

Date of additional claim*

Cause of Loss*

Please detail a description of the claim(s)

Cost of additional claim:*

in £

Please tell us any additional information about the claim(s)

Please list any further claims

Are you and everyone residing at the property a UK Resident?*

Have you or anyone living at the property ever been refused insurance, or had any special terms imposed?*

Have you or anyone living at the property ever had a County Court Judgement (CCJ) or IVA (individual voluntary arrangement) or Debt Arrangement Scheme (DAS) or unspent/unsatisfied bankruptcies? (if yes please give details)*

Details

Have you or anyone living at the property been charged with or convicted of any offence (other than motoring offences) received a police caution or have any pending prosecution that should be declared as per the Rehabilitation of Offences Act 1974?*

General information or outstanding matters:

We continually assess our product offerings and collaborate with our insurers to secure the most competitive premiums for our clients. We're also exploring potential discounts for customers who choose to insure multiple products with us. To better understand which products and services our customers might like us to offer in the future, please let us know your areas of interest below:

Equine Insurance

Classic Car Insurance

Pet Insurance (dog/cat)

Private Medical Insurance

Other

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CALL US: 01795 844939

CALL US: 01795 844939

Request a Quote

POLICY HOLDER DETAILS

THE ADDRESS TO BE INSURED

Further Details

PROPERTY DETAILS

THATCHED PROPERTY DETAILS

HOW IS THE PROPERTY OCCUPIED?

SECURITY & FIRE PROTECTION INFORMATION

COVER REQUIRED

ADDITIONAL INFORMATION

Additional Claims

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