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In order to provide you with a quote to insure your rental property we will need a few details from you, please fill in the following form and we will get a bespoke quote ready for you.
Your policy is a contract of insurance between you and your insurer and you have a duty to make a fair presentation of the risk in accordance with the law. This applies prior to the start of your policy, if any variation is required during the period of insurance and prior to each renewal.
If you do not make a fair presentation of the risk and fail to advise of any inaccuracies or omissions your policy may not protect you in the event of a claim. The insurers may at their option; Cancel, declare your policy void, change the terms of your policy, refuse to deal with all or part of any claim or reduce the amount of any claims payments.
Name
*
First
Last
Date of Birth
*
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MM
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YYYY
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2020
2019
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2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
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1982
1981
1980
1979
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1976
1975
1974
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1949
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1943
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1941
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1938
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1934
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Correspondence Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia (Republic of)
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States of America
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Phone Number
*
Email
*
Other Contact Details
How did you hear about us?
*
-- Select the below options --
Leaders
Romans
Personal Recommendation
Other
Which leaders branch?
*
Which romans branch?
*
Comments
*
Comments
*
Next
Declaration
Have you ever had an insurance proposal or renewal declined, cancelled, voided or special terms imposed?
*
Yes
No
Have you been convicted of or charged (but not yet tried) or been given a police caution in respect of any criminal offence other than a motoring offence?
*
Yes
No
Have you ever been declared bankrupt or insolvent or disqualified from being a company director or been involved as a partner/manager to a company which went into receivership/administration or liquidation?
*
Yes
No
Have you been the subject of any County Court Judgement, Individual Voluntary Arrangement or Company Voluntary Arrangement?
*
Yes
No
Have you been investigated or prosecuted by HM Revenue and Customs investigations?
*
Yes
No
Next
Tenants
Do you let to: Working tenants?
*
Yes
No
Do you let to: Retired tenants?
*
Yes
No
Do you let to: Housing Welfare?
*
Yes
No
Do you have an HMO (House of Multiple Occupation)?
*
Yes
No
Do you have a written assured short hold tenancy agreement in place?
*
Yes
No
Do you take references for tenants (either by credit/landlord or use a managing agent)?
*
Yes
No
What is your minimum tenancy period?
*
6 months
12 months
24 months
Next
Rental Property
Rental Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia (Republic of)
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States of America
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
How long have you owned the property?(Years)
*
Months
*
Is the property occupied at the moment?
*
Yes
No
If no, how long has it been empty?
0 Months
1 Months
2 Months
3 Months
4 Months
5 Months
6 Months
More than 6 Months
What is the property type?
Flat / Apartment
Maisonette
Bungalow
Terraced
Semi-detached
Detached
If flat / apartment, where is it situated?
Ground floor
First floor
Top floor
Other
Does the property include a basement?
*
Yes
No
If yes, select basement type
*
Inhabited
Parking
Storage
What year was it built?
*
Is it a listed building?
*
Yes
No
If yes, Grade 1 or Grade 2?
Please select
Grade 1
Grade 2
How many bedrooms?
*
How many bathrooms?
*
What’s the construction of the building?
*
Please select
Timber
Brick
Concrete
Steel
What is the construction of the roof?
*
Please select
Tiles
Slate
Felt
Other
Do you have a flat roof?
*
Yes
No
If yes, what % of your overall roof space approximately?
When was the flat roof last inspected? (date)
*
Is the property near a river/stream/watercourse (within 400 metres)?
*
Yes
No
Any history of flooding?
*
Yes
No
Any history of subsidence/landslip/heave?
*
Yes
No
Has it had an electrical inspection in the last 5 years (Valid EIC Certificate held)?
*
Yes
No
How is the property heated?
*
Please select
Gas Fire Central Heating
Fixed Electric Heaters
Other
Building comply with the fire safety order 2005 (flats only)?
*
Yes
No
Not Applicable
Any home claims in the last 5 years?
*
Yes
No
Next
Security
Do you have a 5 lever mortice deadlock (British Standards 3621) on all final exit doors?
*
Yes
No
Key operated window locks on all accessible windows?
*
Yes
No
Do you have an alarm? (bell only or signal)?
*
Yes
No
Any other security measures? (cctv, grilles, shutters, bars in windows etc)
*
Yes
No
Next
Cover requirements
What’s the rebuild value of the property? (index linked or uplift %)
*
Do you need buildings cover?
*
Yes
No
Do you need contents cover?
*
Yes
No
Loss of rent cover required? (This provides indemnity if the property is not habitable due to an insurance claim for the specific period the tenants are unable to reside at the premises)
*
Yes
No
Property owners liability level of cover?
*
£2 million
£5 million
Is employers liability required? (Company owned properties or domestic cleaners/Gardeners)
*
Yes
No
Legal expenses?
*
Yes
No
Current renewal date?
*
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MM
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/
YYYY
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Current premium?
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