About You

To make sure you get our best deal, please enter your name exactly as it appears on your household bills and include your ID Card Number

Your Name & Surname(required)

ID Number (required)

Date of Birth (required)

Marital Status

Occupation

Tel/Mobile

Your Email (required)

Your Property

Please answer all questions accurately, as incorrect information may invalidate your insurance should you take out a policy.

Addess

Type
VillaTerraced houseBungalowMaisonetteApartmentHouse of CharacterFarmhouse

Year of Build

Value

Does the property have a burglar alarm?
NoYes

For how long will the property be left unoccupied?
Up to 30 daysLess than 90 daysMore than 90 days

Is the property occupied during the day?
NoYes

Your Cover

Please answer all questions accurately, as incorrect information may invalidate your insurance should you take out a policy.

Cover start date

Type of Cover Required
BuildingContentsBuilding and Contents

How many claims or losses have you or anyone to be insured made in the last 5 years?

When is your car insurance due for renewal?

Other Information

Where did you hear about us
 Already a customer Email Friends or family Phone directories Post Press Search engine

Your quote is based on the following assumptions.

If you do not meet these please call on 22058520:

• No person to be insured has ever had any criminal convictions, police cautions or have any prosecutions pending
• No person to be insured has ever had insurance refused, cancelled or offered with terms imposed
• The home has never suffered from flooding and is not in an area at risk of flooding
• The home is not used for any business purposes
• The home is in a good state of repair
• The home is not used as a holiday home or weekend home

Your quote will be based on the assumptions and the answers to the questions in this application. Please tick the box to confirm that you agree with all of the assumptions.

Please enter the characters you see in the field provided