Risk Details
Number of Occupants 18 years old and above
Number of Occupants under 18 years old
Value of Buildings Sum Insured £
Value of Contents Sum Insured £
Value of Specific Items Insured £		Add up the value of all items individually valued at £500 or more, and type the total into field on the left.eg: Wedding Ring: £650 Video Camcorder: £900 Binoculars: £520 Value of specified Items Insured £2070
Have you ever been refused Insurance	YesNo
Has anybody residing at the address ever been convicted of fraud or theft?	YesNo

Please answer all of the following questions in full:

Please confirm that the Premises are:
NOT at any time used for Professional Services ?	Yes No
NOT regularly left unattended by day or night	Yes No
Built of brick, stone or concrete ?	Yes No
Roofed by either slate or tile ?	Yes No
In a good state of repair and condition?	Yes No
Free from flooding ?	Yes No
Free from signs of Subsidence ?	Yes No
Free from any signs of External Cracks ?	Yes No
NOT built in an area known for underground workings ?	Yes No
Fitted with Security mortice deadlocks to external doors ?	Yes No
Fitted with window locks to all windows ?	Yes No
If you have answered No to any of the above questions in this section, please give further details.	-

Additional Information
Type of Property	FlatMaisonetteTerraced HouseSemi Detached HouseLink Detached HouseDetached House
If a flat, on what floor is it situated ?	Leave as 0 for ground floor
Do you have a safe fitted ?	Yes No
If a safe is fitted details please:
Is the property fitted with an alarm system ?	Yes No
If so , please give details?
Is the Alarm System connected to "RedCare"	Yes No
Have you suffered any claims in the last 5 years	Yes No
If you have answered "Yes" to above, please complete the details below giving Value, Month and Year
If Yes to above, what was the: Value of Claim No.1 Date of Claim Details of Claim	£ Date (In "dd / mm / yyyy" format eg. Xmas is 25 /12 /1998) Details:-
Value of Claim No.2 Date of Claim Details of Claim	£ Date (In "dd / mm / yyyy" format eg. Xmas is 25 /12 /1998) Details: -
Value of Claim No.3 Date of Claim Details of Claim	£ Date (In "dd / mm / yyyy" format eg. Xmas is 25 /12 /1998) Details: -