| EMAIL ADDRESS |
|
| |
The address that documents will be sent to |
| |
|
| CONTACT PHONE NUMBER |
|
| HOW DID YOU HERE ABOUT CLICK4QUOTE.COM |
|
| |
(If you have a marketing code please enter it here). |
| |
| CORRESPONDENCE ADDRESS |
| HOUSE NAME/NUMBER & STREET |
|
| POST CODE |
|
| |
|
| TITLE |
|
| LAST NAME |
|
| INITIALS |
|
| NATIONALITY |
|
| |
|
| |
|
| POSTCODE OF PROPERTY TO BE INSURED |
|
| |
| BUILDINGS SUM INSURED |
|
| |
|
| CONTENTS SUM INSURED |
|
| |
|
PLEASE CONFIRM
THE STATUS OF TENANTS |
|
 |
Please state the number
of tennants per dwelling
|
|
|
| Type of Property: |
|
|
| If the type of property you have selected is bedsits or a block of flats, please state how many there are: |
| |
|
| If you have selected 'block of flats' we must be insuring the whole block for an online quotation and the sum insured must be a minimum of £35,000 for each flat. |
| |
Landlords Legal Protection Insurance provides access to a 24 hour legal helpline
and cover against criminal prosecutions at just £19.00 per property.
For more information please view the links above.
|
| DO YOU REQUIRE THIS COVER? |
|
| |
HOW TO COMPLETE THE GENERAL QUESTIONS BELOW
If your answer to the question IS NOT shown (YES or NO), go to the next question.
If your answer to any of these questions IS shown, then tick the box. |
|
If a question is marked **, and you tick its box, we require further details before we can offer you a quotation. However, please continue to complete the form and then enter relevant further details into the text box at the end of this form and submit the application.
We will then contact you with a quotation response. |
|
| |
HAVE YOU, YOUR COMPANY, OTHER DIRECTORS OR PARTNERS OR
ANY MEMBER OF YOUR FAMILY NORMALLY RESIDING WITH YOU... |
| ** Suffered any loss, damage or liability within the last five years? |
|
| ** Had insurance proposal declined, renewal refused, cover terminated or special terms imposed? |
|
| ** Been convicted of any criminal offence (other than motoring offences)? |
|
| |
| IS THE DWELLING... |
| In an area where flooding has occurred within the last 10 years? |
|
| Built of brick stone or concrete and roofed with slate or tiles? |
| If NO, please specify below: Buildings |
|
|
| |
|
|
| |
| **If you have answered any of the 'GENERAL QUESTIONS' and they require further information, please give further details here. |
|
|
YOU DECLARE
By submitting this form for a quotation you declare that to the best of your knowledge and belief that the above statements and particulars are true and complete and you have not withheld any material fact. You are the legal owner of the property detailed in this proposal form and will declare any additional financial interest. You agree to accept the company's standard form of policy for this type of insurance and that we may contact your previous insurer to verify any information that you have provided.
IMPORTANT - Material facts are those likely to influence the acceptance or assessment of this proposal and it is essential that you disclose them If you are in any doubt as to whether a fact is material or not you should disclose it as failure to do so could invalidate your policy. You should keep a record (including copies of letters) of all information you have supplied to the company that relates to this proposal. Your buildings sum insured should represent the full replacement value of your property (including an allowance for professional fees and demolition) and the contents sum insured should represent the full replacement value of all contents at todays prices - Underinsurance will adversely affect any future claims.
SUITABILITY STATEMENT
This product meets the demands and needs for those wishing to ensure their buildings and/or contents replacement costs are met now, or in the future, whilst their residential property is let. |
We may on occasions wish to inform you of other products/services we offer, or details we feel may be of interest to you. Please tick the box to indicate you do not wish to receive this information
I DO NOT wish to receive details on other products/services/details from CLICK4QUOTE.COM
CLICK4QUOTE LIMITED may on occasion pass your details on to specially selected third parties which we think you would be interested to hear from. Please check the box if you DO NOT which to receive this information.
Unless you have ticked the appropriate box above to object, by clicking 'Click 4 Quote' you are consenting to receive marketing messages from us/third parties by e-mail/other forms of electronic communication, or by mail/phone |
|
