Property Enquiry

Company Name:

Contact Name:

Telephone Number:

Email Address:

Insured Name:

Business Description:

Risk Address:

Town:

County:

Postcode:

Name of Tenant:

Current / Intended Occupation:

Is the property vacant or part vacant?YesNo

If yes, how long has it been unoccupied?:

How long will it remain vacant (Estimate)?:

What security precautions are in place?:

What percentage of the property is vacant?0%10%20%30%40%50%60%70%80%90%100%

Is the property listed?NoGrade IGrade IIGrade III

Age of Property:

Number of Storeys:

Construction of WallsBrickStoneOther

Construction of RoofSlateTileConcreteAsphaltOther

Construction of floors above GroundWoodConcreteOther

Is any portion of the roof flat?YesNo

If yes, approximate percentage of area:

Buildings Declared Value:

Rent Sum Insured (per annum):

Indemnity Period12 Months24 Months36 Months

Landlord Content Sum Insured:

Contents (communal) Sum Insured:

Property Owners Liability£2,000,000£5,000,000£10,000,000

Employers Liability Cover Required?YesNo

Wage Roll:

Number of Staff:

Nature of Staff:

Have there been any claims settled or submitted or any incidents that could give rise to a claim in the last five years?YesNo

Please give details of claim(s)

Have there ever been any claims for subsidence?YesNo

Please give details

Terrorism Quote Required?YesNo

Engineering Required?YesNo

Legal Expenses Required?YesNo

Additional comments or requirements

Holding Broker?YesNo

Current Insurer:

Any other insurer/ broker approached for a quotation?YesNo

Renewal Date:

Current Premium (in IPT):

Target Premium (inc IPT):

Current Excess:

Deadline Date: