Leasehold Landlord Application Form

Policyholder Name

Property Address

Postcode

Correspondence Address

Postcode

Are you domiciled in the European Economic Area? YesNo

Telephone Number

Email Address

Start Date (This cannot be backdated, and the earliest cover can start from is the date this application is received by Bode)

Cover Details

The sums insured will be fixed at £2,000,000 for leasehold liability and £10,000 for contents.

Disclosure of Information

The question on this form relate to facts considered material to underwriting the insurance. If you answer them fully and honestly you will be considered to have fulfilled your duty to disclose material facts. Failure to do so may invalidate your insurance. If you are in doubt please advise us.

Have you ever suffered loss whether covered by insurance or not, made any claims or been involved in any incidents which could have resulted in a claim in respect of the risks proposed within the last 3 years?

YesNo

Have you ever had an insurance proposal or renewal refused, or policy cancelled, or special terms imposed for the risk proposed?

YesNo

Have you ever been declared bankrupt or currently have any legal insolvency arrangements with creditors?

YesNo

Have you ever been charged, convicted or cautioned for a criminal, health & safety, welfare or environmental offence other than Road Traffic Law offences?

YesNo

Is the property used for short lets (i.e. Assured Shorthold Tenancy)?

YesNo

Is the home let to asylum seekers or DSS referrals?

YesNo

Will the property be unoccupied for a period exceeding 45 days?

YesNo

Is the property of standard construction of brick, stone or concrete and roofed with slates, tiles?

YesNo

Notes

Cover will not apply to personal possessions or valuables left at the property. Dependent upon the values insured, certain Minimum Security Standards may apply.

Declaration

I/we declare that the information given is, to the best of my/our knowledge and belief, correct and complete. I/we agree that the insurance will not be in force until this application has been accepted by Bode.

Annual Premium

Select Monthly or Yearly Premium

£7.88 per month£84.00 annually

If you have opted to pay monthly, please provide your bank details below:

Account Name

Sort Code

Account Number

Extra Information

Data Protection

I agree that the data supplied on this website page will be used exclusively by Bode Insurance Solutions to process the application and will not be used for any other purpose by Bode Insurance Solutions or by third parties such as marketing.