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Home Insurance
 

Home Insurance Quotation Form

*indicates Required Fields

Full Name*

   
Email Address*
   
Date of Birth*
   
ID Number*
   
Business or Occupation*
   
Telephone No
   
Mobile No
   
Partner Details (if applicable)

Full Name

   
Date of Birth
   
ID Number
   
Business or Occupation
   
   
Period of Cover:
From*
To*
   
Address of Proposer*
   
Address of Property to be Insured*
   
General Questions
   
1. Have you or any of the members of your family normally residing with you:
   
a) suffered any loss, damage or liability from any cause within the last five years?

b)
had a proposal declined, a renewal refused, cover terminated, special terms or conditions imposed by an Insurer?

c) been convicted, or charged but not yet tried, for any offence other than driving offences?

   
   
2. Are the buildings situated at the address of the Propery to be insured:
   
a)
house?
bungalow?
   
maisonette? flat?

b)
left without an adult resident for more than 90 days in a row?

c) in a good state of repair and will be so maintained?

d) built of brick, stone or concrete and roofed with slate, tiles, concrete, asphalt, metal sheets or slabs composed entirely of incombustable mineral ingredients?

e) occupied by you and your family and used only as a private residence?

     
     
3. Are you or have you previously been insured for your Home Buildings or Contents?
     
 
Name of Insurer
(if applicable)
   

Policy Numbers
(if applicable)

 

   
   
4. If your premises are protected by an intruder alarm, please tick the relevant boxes and answer the following:
     
a) the type of alarm  
   

b) the name of the installing firm  
   

c) the date the system was installed  
   

d) is the alarm subject to an annual maintance contract?

e) do you wish to apply for the intruder alarm discount?

     
     
Buildings (if applicable)
Please answer the following questions if the Buildings are to be insured and state the sum to be insured.
   
1. What is the required Sum Insured based on the rebuilding cost as new?

2. Would you like to apply for the Enhanced Cover to extend accidental damage to your Buildings?

3. Please give the year the property was built (approximate date if not known)

4. Please state the name and address of any Lessee or Mortgagee whose interest in the Building is to be named in the Policy
   
Contents (if applicable)
Please answer the following questions if the Contents are to be insured.
   

1. What is the current required Sum Insured based on the full replacement value as new of your Contents situated at the Address of the Property to be insured?


2. Would you like to apply for the Enhanced Cover to extend accidental damage to your Contents?
 

3a)

What is the current total amount of valuables* included in the Contents sum insured in (1) above?

Valuables means stamp, coin or medal collections, antiques (not including furniture) collectibles, pictures, paintings and other works of art, items of gold, platinum, silver, or other precious metals, jewellery, watches and furs. No one single valuable is worth more than €2,320.37 unless specifically insured as a separate item.


b) Specify all single valuable items exceeding € 2,329.37  
     
  Description
Value in Euro
 
     

c) Do you want to cover any one single item of audio, audio-visual and home computer and entertainment equipment for accidental damage which exceeds the limit of €2,329.37?
     
  If Yes, please specify such items:  
     
  Description
Value in Euro
 
     

4. If you would like to extend the policy limit on Pedal Cycles and Sports Equipment cover, please provide details and value:

   
Details
Value in Euro
   
Personal Belongins including Valuable Items (if applicable)
If you require cover for specified valuables please specify each item seperately under this Section.
       
  Description
Geographical Area
Value in Euro
i
       
       

 


Contact Details

These details will be only used by our Sales Representatives to contact you regarding this quotation.

Contact Number*
 
Preferred Calling Time
Between:    
and
   

 
 
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