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HOME INSURANCE APPLICATION

This form is designed to capture the information on which the contract of insurance will be based. All information you provide must be true and correct to the best of your knowledge and belief. Any information that is likely to influence insurers in the assessment or acceptance of your application, such as intended unoccupancy of your home, must be disclosed. If you are in any doubt as to whether a fact is relevant you must disclose it. Please note: you may skip sections of the form but the overall process will be smoother the more information you can give us.

1. Proposer details

2. Joint Proposer details

3. Cover requirements

4. Previous history

5. Property details

6. Sums insured

7. Protections

8. Claim history

  1. (Full description, if Company director state business nature)
  1. (Full description, if Company director state business nature)
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Buildings

Contents


Fine art and collections

Jewellery / Watches only

All specified items above the single article limit of £15,000 for Fine Art and £5,000 for Jewellery must be listed individually with the current market value in the space provided below.

Item Current market value Name and address of bank / safe deposit Action
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General security

Alarm

Fire protections

Safe

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If you or anyone whose property is to be insured has sustained any loss, damage or liability for any events that you wish to insure against, whether insured or not, in the last five years, please give details below.

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  • PROPOSER DETAILS
  • JOINT PROPOSER DETAILS
  • COVER REQUIREMENTS
  • PREVIOUS HISTORY
  • PROPERTY DETAILS
  • SUMS INSURED
  • PROTECTIONS
  • CLAIM HISTORY

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London Office

57-60 Charlotte Road, London, EC2A 3QT

T: 0207 199 3258

F: 020 8812 3930

info@insurancetailors.co.uk

www.insurancetailors.co.uk


Business Hours

Weekday: 8.30am to 5.30pm

Saturday: closed

Sunday: closed

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