fields marked with * are required |
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* Your Name |
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* Your Email Address |
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* Telephone |
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* Name of Proposer 1 |
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* DOB for Proposer 1 |
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* Occupation of Proposer 1 |
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* Name of Proposer 2 |
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* DOB for Proposer 2 |
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* Occupation of Proposer 2 |
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* Risk Address |
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* Risk Postcode |
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* Building Sum Insured |
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* Contents Sum Insured |
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Year Built |
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Listed |
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* Property Type |
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* Number of Storeys |
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Total number of flats in whole building (if flats) |
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Total number of flats to insure (if flats) |
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If not standard construction please state type |
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Flat Roof Area (If Applicable) |
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* The Property is Currently |
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If let / to be let then written tenancy agreement is / will be more than 6 months |
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Yes
No |
If let / to be let then the landlord's agreement is / will be direct with |
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If let / to be let then the tenant(s) are / will be |
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If let / to be let then then what number of single unrelated persons are there / will there be |
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If let / to be let then the tenant(s) are / will be |
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Have you made a claim in the last 5 years |
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Yes
No |
Current Insurers Name |
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Current Policy Expiration Date |
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Any other information |
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