83-91 Woodside Way
Glenrothes, Fife
Phone 01592 756711
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uilding Insurance Quote
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About You
Title:
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Mr
Mrs
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First Name:
Surname
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Street Address
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Town
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Telephone:
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Email Address:
Date Of Birth:
Marital Status:
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Single
Married
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Common Law
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Male
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Occupation:
Smoker:
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Yes
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Do you wish to add a joint policyholder:
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Yes
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Relationship to Proposer:
Spouse
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Son/Daughter
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First Name:
Surname:
Date Of Birth:
Occupation:
Smoker:
Yes
No
D
etails of Your Home
Cover Type:
Building and Contents
Building Only
Contents Only
House Name or Number:
Street Name:
Post Code:
Is Your Property a Listed Building:
Yes
No
Is Your Property:
Mortgaged
Owned
Council Rented
Private Rented
Housing Association
Period Built:
Pre 1837
1837 to 1919
1920 to 1945
1946 to 1979
1980 to 1989
1990 Onwards
Property Type:
Detached House
Semi-Detached House
Terraced House
Maisonette
Detached Bungalow
Semi-Detached Bungalow
Flat - Ground Floor Or Basement
Flat - 1st Floor Or Above
End Of Terrace House
Construction Of Walls:
Brick
Stone
Wooden
Concrete
Other
Construction Of Roof:
Slate
Tiled
Other
Is The Roof:
Pitched
Flat
Other
If Flat Roof, What Percentage Is Flat:
0-10%
10-20%
21-50%
Over 50%
100%
Number of Bedrooms:
1
2
3
4
5
Any Previous Subsidence/Underpinning Of House
Yes
No
Building and/or Contents Insurance
Building Sum Insured (Rebuilding Cost):
Building - Type of Cover Required:
Standard
Accidental Damage
Contents Sum Insured:
Contents - Type of Cover Required:
Standard
Accidental Damage
All Risks Cover (items taken out of the home)i.e. jewellery, cameras, pedal cycles, sports equipment, golf equipment etc
Enter total Sum Insured required:
Maximum Sum Insured required for any one item
Renewal Date Of Policy/Start Date
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0
1
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5
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30
31
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Jan
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Mar
Apr
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Jul
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Sep
Oct
Nov
Dec
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2008
2009
2010
Additional Details (Security)
Do you have a professionally installed and maintained alarm system in your home:
Please Select
Yes
No
Do you have an alarm system that will automatically contact the police:
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Yes
No
Do you have 5 lever mortice locks on exit doors:
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Yes
No
Do you have window locks fitted:
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Yes
No
Previous Claims (if applicable)
Claim 1
Date of Incident:
Details
(please describe)
Amount Paid Out:
Claim 2
Date of Incident:
Details
(please describe)
Amount Paid Out:
