Helpline: 01392 287400

Quotation Request

Home Insurance

Personal Information
Current Insurance Information
Claims History
Interested Parties
Description of the Property to be Insured
Statement about the property to be insured
Security Details
Buildings Information
Contents Information
Business Use
Additional Cover
Notes
Documents Only

Personal Information

Full Name
Date of Birth
Please select your current full time occupation:
Nature of Business
Are there any other persons to be named on this Policy?
Please give details of any other persons to be named on this policy
TitleFirst NameSurnameDate of BirthOccupation
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Correspondence Address
Is the address of the property the same as the correspondence address?
Address of Property to be Insured
Telephone Number
E-Mail Address


Have any members of the household had any prior or pending criminal convictions (other than motoring)?
Please provide details including date(s), charge(s) and circumstance(s).
Have any members of the household had CCJ’s or been subject to any bankruptcy or winding up proceeding?
Please provide details including date issued, amount due/written off and current status (ongoing, spent etc.)
 
PostcodeNoSpace
Postcode Rating Band
BuildingsCode
ContentsCode
Subs
Flood
Trade Code

Current Insurance Information

Do you currently hold Insurance at the address of the property to be insured?
Current Insurer
Current Premium
£
Current Excess
£
What is the expected start date of this policy?

Claims History

Have you, or anyone normally living with you had any property or possessions stolen, lost or damaged, or any claims in the last 5 years?
Please provide details of all claims below
TypeDateofLossAmountofLossClaimsStatusClaimDetails
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Interested Parties

Are there any interested parties to be noted against the property to be Insured? E.g. Banks or mortgagees?
Please provide details of one or more interested parties below
NameAddress Line 1Address Line 2TownCountyPostcodeRef
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Description of the Property to be Insured

Year of Build:
How long have you lived in or owned the property to be Insured?
Is the property to be insured a Listed Building?
Listed status:
Please provide details of the construction of the floor:
Please provide details of the construction of the roof:
Does any of the property to be insured have a flat roof area?
Percentage of flat roof:
%
 

DECLARATION

Please note as a consumer insured (i.e. a person buying insurance wholly or mainly for personal purposes unrelated to your employment), you have a duty to take reasonable care to answer questions fully and accurately. This duty exists before the cover is placed and throughout the entire duration of the Insurance. If you do not do so, insurers may be able to avoid the Policy from inception.

- I declare that to the best of my knowledge and belief the information provided in connection with this application, is true and complete and I have not have not withheld or misrepresented any information.
- I agree for underwriters to act upon the information provided and issue a contract of insurance between us and accept underwriters' policy terms, conditions and exclusions.
- I agree to inform underwriters of any changes in circumstances from the date of this application and understand that cover will not commence until confirmed by us.
- I consent to the seeking of information from other insurers to check any answers provided and authorise the giving of such information for such purposes.
- I understand that if any information is found to have been withheld or misrepresented in this proposal, underwriters may be entitled to void the insurance.
 
SISS may also wish to contact you from time to time to inform you of any improvements in cover, new products, exclusive discounts or insurance news that may be of benefit or interest to you. If you do not wish to be contacted, please check here.
Liability Load
£
DISCOUNT-Building-Sum Insured
£
DISCOUNT-Building-Age
£
DISCOUNT-Contents-Sum Insured
£
DISCOUNT-Contents-Security
£
DISCOUNT-Age
£
DISCOUNT-No Claims
£
DISCOUNT-Loyalty Renewal
£
DISCOUNT-Combined Policy
£
DISCOUNT-Buildings Excess
£
DISCOUNT-Contents Excess
£
DISCOUNT-Business-Trading History
£
DISCOUNT-Business-Alarm
£
DISCOUNT-Total-Buildings
£
Discount-Total-Contents
£
DISCOUNT-Total-Business
£
Maximum Allowed Discount (Ex. Voluntary Excess Discount)
£
Maximum Allowed Discount (Ex. Voluntary Excess Discount)
£
Maximum Allowed Discount (Ex. Voluntary Excess Discount)
£

Statement about the property to be insured

Will the Property be occupied solely by you and your immediate family as your main residence?
Please provide details:
Have you ever had insurance refused, declined, cancelled or had special terms imposed?
Please provide details:
Will the property be left unattended for more than 60 consecutive days?
Please provide details:
Is the property in a good state of repair and well maintained
Please provide details:
Is the property at least 250 metres from any watercourse, river, stream or tidal water?
Please provide full details including distance from watercourse:
Have the property or the surrounding area within 250 metres of the property ever flooded? (Including garden or basement)
Is the property in the vicinity of any cliffs, quarries or known underground working?
Please provide details:
Is the property free from any visible signs or subsidence or movement (cracking or bulging)?
Please provide details:
Has any part of the property to be insured ever been underpinned or required any other remedial work in connected with subsidence, leave or landslip?
Please provide details
Are there any trees or shrubs within 10 metres of the building which are more than 3 metres tall?
Please provide details including type of tree(s), distance from property and height
Is the property used for any business, trade or professional purposes other than clerical work
Please provide details:
Claims 1yr Count
Claims 2yr Count
Claims 3yr Count
Claims 4yr Count

Security Details

Are final exit doors secured by mortice deadlocks with at least 5 levers or a rim deadlock conforming to British Standard 3621 or, if the door(s) are UPVC or double glazed, a multi-point locking systems with either a lever or built-in deadlocking cylinder?
Please provide details
Are all opening sections or the basement, ground floor and easily accessible windows, fanlight and skylights to the property secured by key-operated locks?
Please provide details
Is the property to be insured within a neighbourhood watch area?
Is the property fitted with a burglar alarm?
Was it installed by a NSI/SSAIB approved installer?
Is it covered by an annual maintenance contract?
Does the property have a safe?

Buildings Information

Do you require cover for buildings?
Would you like to include accidental damage?
Buildings Sum Insured (Rebuild Cost)
£

Contents Information

Do you require cover for contents? Items permanently within the home
Would you like to include accidental damage?
General Contents Sum Insured
£
Do you require cover for Fine Art and/or Antiques?
Total Fine Art / Antiques Sum Insured
£
Please specify all Fine Art / Antiques items valued over £5,000
Item DescriptionValue / Sum Insured
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Do you require cover for personal possessions? Items in and away from the home
Personal Possessions Sum Insured
£
Valuables / Jewellery / Furs Sum Insured
£
Please specify all Valuables / Jewellery/ Furs valued over £1,500
Item DescriptionValue / Sum Insured
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Laptops Sum Insured
£
Mobile Phones Sum Insured
£
Pedal Cycles Sum Insured
£
PersonalPedalCyclesIncluded
£
PersonalPedalCyclesRated
£
Guns Sum Insured
£
Any other Person Possession not listed
Item DescriptionValue / Sum Insured
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Business Use

Is the Property used for any business, trade or professional purpose?
How many business callers visit the property per month?
How many years have you been trading?
Do you require cover for business contents?
General Business Contents Sum Insured (furniture, desks, cabinets etc)
£
Business Equipment – Computers etc (within the premises)
£
Portable Business Equipment (in and away from the premises)
£

Family Legal Protection (optional)

Family Legal Protection
DAS Family Legal Protection is designed to provide expert legal help and assistance and offers financial support up to £50,000 for a range of legal disputes such as:- Employment Disputes, Consumer Contract Disputes, Personal Injury, Neighbour Problems, HM Revenue & Customs Investigations & Identity Theft. Cover also allows access to various invaluable helpline services for Legal Advice, Tax Advice, Health & Medical Information, Counselling and Identity Theft. Please Click here to see the DAS Legal Protection Brochure.
Do you wish to include Family Legal Protection cover?
Legal Expenses Fee
£
 

Home Emergency (optional)

New Question
This will add £18.79 + IPT to your policy premium
DAS Home Emergency is designed to provide help following domestic emergencies 24 hours a day, 365 days a year. The policy covers up to £500 for Roof Damage, Plumbing & Drainage, Main Heating System, Power Supply, Toilet Unit, Home Security &/or Lost Keys. The emergency helpline can select from over 22,000 approved contractors to attend and make emergency repairs to prevent further damage and make your home safe & secure. Please Click here to see the DAS Home Emergency Brochure.
Do you wish to include Home Emergency protection?
Home Emergency Fee
£
 
Do you wish to disclose any additional information that you feel may be important to an underwriters assessment of this risk?
Please provide any additional information or further details here

Additional Notes

Additional Notes

Documents Only

Policy prefix to show on Documents
Broker Name
Broker Address
Broker Phone
Broker Fax
Scheme Contact Email
Broker FSA
Contract Number
Policy Status (do not change)
1 = First Premium
2 = Adjustment
3 = Renewal
4 = Cancellation