1. Personal Information
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| Proposer Name * |
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Date of Birth
Please Select the Day, Month & Year you were born |
| Day: * |
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| Month: * |
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| Year: * |
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| Occupation * |
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| Telephone * |
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| Email * |
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| What Directed You To Our Website?: * |
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| Correspondence Address * |
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| Postcode * |
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| Address to be Insured, if different |
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| Postcode |
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2. Property Details
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| Type of Property * |
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| * |
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| Year Built * |
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| Number of Bedrooms * |
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| Is the property your main residence? * |
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| Is the property normally occupied on a daily basis? * |
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| Is the property of standard construction (Brick walls and Pitched Tiled roof)? * |
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| Is your property Listed? * |
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| If Yes what grade? |
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| Is your property Thatched? If no, go to question 6 * |
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If yes, please complete the following questions:
3. The Roof
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| Type of roofing material used |
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| Depth of thatch? |
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| Percentage of roof that is thatched |
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| When was the roof last re-thatched? |
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| When was the ridge last renewed |
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| When was the thatch last inspected by a thatcher? |
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| Has all the recommended work been carried out? |
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| Thatch condition? |
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| What fire precautions does the property benefit from? |
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4. The Heating & Chimneys
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| Are open fires or solid fuels stoves ever used? |
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| How are the chimneys utilised? (Select all applicable options) |
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| Please state further details (If central heating, please enter fuel type) |
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| Is the chimney professionally lined & insulated to the Woodburner? |
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| Is the chimney professionally lined & insulated to the open fire? |
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| If the property is less than 100% thatch and you have solid fuel stoves, are these situated under the area of thatched roof? |
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| How many chimneys are there? |
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| Has the chimney been swept in the last 12 months? |
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| What height is the chimney above the ridge (the pitch of the roof)? |
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| Do you have spark arrestors? |
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5. General Questions
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| How far is the nearest fire brigade? |
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| Has a full electrical periodic inspection been carried out by an NICEIC qualified electrician in the last 10 years? |
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| When was the electrical wiring last inspected? |
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| Can a full copy of the report be provided? |
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| Was all the recommended work completed? |
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| Does the property have fire extinguishers? |
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| If yes, please advise type and where kept |
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| Does the property have a fire blanket in the kitchen? |
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| Is the property connected to a mains water supply? |
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| Are there any additional sources of water available? (e.g. lake, swimming pool, river or stream)? |
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6. Previous Insurance & Claims History |
| Renewal date / Cover required from * |
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| Current / Previous Insurer |
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| Renewal premium |
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| Please confirm how long you have held contents insurance for? * |
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| Please confirm how long you have held buildings insurance for? * |
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| Please confirm details (date/claim info/amount) of any claims you have made under any Buildings or Contents insurance policy in the past 5 years: |
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7. 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.
8. Buildings |
| Buildings sum insured (to represent the full re-building cost of your home – For further information visit http://abi.bcis.co.uk) |
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| Outbuildings sum insured |
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Contents |
| General contents |
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| Is accidental damage and worldwide cover required? |
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| Wine collection |
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| Ride on mowers, tractors or quad bikes |
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Fine Arts & Antiques |
| Outdoor items (e.g. garden furniture, statuary or urns) |
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| Household gold, platinum, silverware, porcelain and glass |
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| Paintings, drawings, maps, prints, photographs, books, manuscripts, tapestries and rugs |
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| Antique and/or designer furniture |
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| Clocks, barometers, curios, statues, sculptures, stamps, coins, medals, musical instruments, antique guns and other collections |
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Valuable/Personal Possessions/Specified Items |
| Personal possessions (total value of items regularly removed from the home e.g. pedal cycles, cameras, mobile phones etc) |
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| Jewellery and watches normally worn |
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| Jewellery and watches kept in a safe |
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| Jewellery and watches kept in bank vault or safety deposit |
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| Saddles and tack |
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| Guns |
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| Money |
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| Credit Cards |
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| Please list any single item to be insured which exceeds £5,000 in value |
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| Please list any pedal cycle to be insured which exceeds £1,000 in value |
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| Are there any other specific requirements for the insurance policy? |
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| Is there any renovation/construction work in progress or planned for next year? * |
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| Are there any signs/history of subsidence, heave or landslip? * |
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| Is there any history of flood or is the property situated within ¼ mile of watercourse or sea? * |
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| Is the property used in connection with trade or business? * |
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| Is the property occupied by any non-family members? * |
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| Are there any trees within influencing distance? * |
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| Have you ever had any previous terms imposed by insurers or had renewal refused? * |
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| Has any resident received a criminal conviction or have a prosecution pending? * |
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| Has any resident received any county court judgements or declared themselves bankrupt? * |
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| Please supply any further details: |
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9. Locks |
| Are all external doors secured by 5 lever mortice deadlocks? * |
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| If No, please advise type of locks |
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| Are any patio doors secured with top and bottom locks? |
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| If No, please advise type of locks |
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| Are all accessible windows and skylights secured by key operated window locks? * |
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| If No, please advise type of locks |
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Alarms |
| Burglar Alarm |
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| Fire Alarm * |
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| Smoke Detectors * |
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| If Yes, are they battery or mains |
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Safe |
| Do you have a safe installed? * |
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| If yes, please confirm the make and model |
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| Is the safe fitted to the wall, anchored to the floor or free standing? |
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| Please confirm the cash rating of the safe |
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| Is there any other security information to be taken into account e.g. neighbourhood watch? |
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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 will take reasonable care to answer all the questions honestly and to the best of my knowledge, as failure to do so may mean the cancellation of my policy and or my claim being rejected
- 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).
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Agreement |
| I have read and agree to the terms and conditions above: * |
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