Name:
Email address:
Telephone number:
Insured Postcode:
Building Sum Insured:
Content Sum Insured:
Tenancy Type:	Please select Holiday and second home Holiday Home Let D.S.S. Let Landlord / Tenant D.S.S. Let Landlord / Council Student Let Professional Let Asylum seekers Bedsits - 1 to 6 Occupants Bedsits - 7 to 10 Occupants Unoccupied Level 1 (To be let - 12 month) Unoccupied Level 1 Plus (To be let - 12 month) Unoccupied Level 2 (To be let - 12 month) Unoccupied Level 1 (To be sold - 12 month) Unoccupied Level 1 Plus (To be sold - 12 month) Unoccupied Level 2 (To be sold - 12 month) Unoccupied Level 1 (To be sold - Short Term) Owner Occupied Unoccupied Level 1 (To be owner occupied) Unoccupied Level 2 (To be owner occupied)
A.D. Extension:	No Yes
Policy duration:	Please select 6 months 3 months
Property Type:	Please select House Bungalow Maisonette Block of Flats Individual Flat
Grade Listed:	Please select Not applicable Grade 1 Grade 2
Flat Roof:	Please select Not applicable 1% - 49% 50% - 74% 75% - 100%
Voluntary Excess:	0 500 1000 2500 5000 10000
Please complete the form