Proposer Information
Proposer Name: *
Occupation(s): *
Date of Birth
Please Select the Day, Month & Year you were born
Day: *
Please select
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Month: *
Please select
January
February
March
April
May
June
July
August
September
October
November
December
Year: *
Please select
1910
1911
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2011
E-mail *
Daytime Telephone Number: *
Correspondence Address: *
Address to be Insured (If Different):
What Directed You To Our Website?:
Property Details
Type of Property: *
Please select
House
Bungalow
Self Contained Flat
Bedsit
Other
Property Status: *
Please select
Detached
Semi - Detached
Terraced
Other
Year Property Built: *
Number of Bedrooms: *
Is the property your main residence? *
Do you own the property? *
Is the property of standard construction (brick walls and pitched tiled roof)? *
Is the property normally occupied on a daily basis? *
Will the property be unoccupied for more than 30 consecutive days? *
Is the property listed? *
Is there any renovation/construction work in progress or planned for next year? *
Are there any signs/history of subsidence, heave or landslip? *
Is there any history of flood or is the property situated within 1/4 mile of watercourse or sea? *
Are there any trees within influencing distance? *
Is the property used in connection with trade or business? *
Is the property occupied by any non-family members? *
Have you ever had any previous terms imposed by insureers or had renewal refused? *
Has any resident received a criminal conviction or have a prosecution pending? *
Has any resident received any county court judgements or declared themselves bankrupt: *
Please supply futher details where necessary:
Locks
Are all external doors secured by 5 lever mortice deadlocks? *
Are any patio doors secured with top and bottom locks? *
Are all accessible windows and skylights secured by key operated window locks? *
Alarms
Burglar Alarm - Bells/Siren only *
Burglar Alarm - Connected to a central monitoring station: *
Fire Alarm *
Smoke Detectors *
Safe Details
Do you have a safe installed? *
If yes, please confirm the make and model:
Is the safe fitted to the wall, anchored to the floor or free standing? *
Please confirm the cash rating of the safe: *
Is there any other security information to be taken into account e.g. Neighbourhood Watch?
Additional Information
Previous Insurance & Claims History
Renewal Date/Cover required from: *
Current/previous Insurer *
Renewal Premium *
Please confirm how long you have held contents insurance for: *
Please select
One Year
Two years
Three Years
Four Years
Five + Years
Please confirm how long you have held buildings insurance for: *
Please select
One Year
Two years
Three Years
Four Years
Five + Years
Please confirm details of any claims you have made under any Buildings or Contents insurance policy in the past 5 years:
Cover
Please confirm the sums to be insured by completing the table below. If you require any assistance completing this table or are interested in having a professional valuation or a risk management survey, please contact us to discuss further.
A number of our insurers will automatically include full accidental damage and provide cover for all of your contents on a worldwide basis. If this is not required please indicate below.
Buildings
Buildings sum insured *
(to represent the full re-building cost of your home - for further information visit http://abi.bcis.co.uk
Outbuildings sum insured: *
Contents
General Contents: *
Is accidental damage and worldwide cover required? *
Wine Collection: *
Outdoor items (e.g. garden furniture, statuary or urns): *
Ride on mowers, tractors or quad bikes *
Fine Art & Antiques
Household gold, platinum, silverware, porcelain and glass: *
Paintings, drawings, maps, prints, photographs, books, manuscripts, tapestries and rugs: *
Antique and/or designer furniture: *
Clocks, barometers, curios, statues, sculptures, stamps, coins, medals, musical instruments, antique guns and other collections: *
Valuables/Personal Poessessions/Specified Items
Personal Possessions (total value of items regularly removed from the home e.g. pedal cycles, cameras, mobile phones etc. *
Jewellery and watches normally worn: *
Jewellery and watches kept in a safe: *
Jewellery and watches kept in bank vault or safety deposit: *
Saddles and tack: *
Guns: *
Money: *
Credit cards: *
Please list any single item to be insured which exceeds £5,000 in value: *
Please list any pedal cycle to be insured which exceeds £1,000 in value: *
Are there any other specific requirements for the insurance policy? *
Terms & Conditions
I understand Ryan Insurance Group use a select panel of insurers for this type of business
My quotation will be valid until the end of the current month
I am obliged to provide all material facts that may affect the rating or acceptance of the policy, as failure to do so could invalidate my insurance cover
Ryan Insurance Group is obliged by law to give me the opportunity to hear how they give advice, deal with compensation and handle complaints. This information is contained within their terms of business agreement (attached).
Agreement
I have read and agree to the terms and conditions above: *