Buildings Sum Insured

(£)

Include Buildings Accidental Damage Cover?

Please Select Yes No

Level of voluntary excess 

Please Select None £50 £100 £150 £200

Name of mortgage provider 

Contents Sum Insured

(£)

Include Contents Accidental Damage Cover?

Please Select Yes No

Level of voluntary excess 

Please Select None £50 £100 £150 £200

How many valuables kept within the home do you wish to specify?

Please Select None 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98

Level of cover for personal possessions away from the home

Please Select None £1000 £2000 £3000 £4000 £5000 £6000 £7000 £8000 £9000 £10000

How many valuables taken away from the home do you wish to specify?

Please Select None 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98

What type of burglar alarm is fitted?

Please Select No Alarm Basic DIY Alarm Approved and Maintained Alarm Approved and Maintained Alarm with 24hr Tel Monitor

How many years no claims bonus do you have?

Please Select None 1 2 3 4 5 6 7 8 9 or More

How many household claims have been made within the last 5 years by you or anyone residing with you?

Please Select None 1 2 3 4 5 More than 5