Personal Information
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| Proposer Name * |
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| Address of property to be insured * |
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| Address for correspondence only * |
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| Postcode * |
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| Email * |
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| Telephone * |
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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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| Additional Occupation |
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| Current Insurer |
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| Current Premium |
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| Renewal Date |
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| What directed you to our website * |
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| Is the property for your own use or commercially let? * |
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| Do you offer any bed and breakfast facilities? * |
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| Number of Letting Units * |
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| Does your property have any additional features eg swimming pools? * |
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Property Details
If you answer yes to any of the following questions please give details under 'Further Information'
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| Age of Property * |
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| Is the property listed? * |
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| Standard construction? (Built of Brick or Stone with Tiled or Slate roof) * |
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| Any renovation or construction work in progress or proposed? * |
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| Any trees on property or on neighbouring property? * |
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| History of, or area liable to, flooding or within ¼ mile of watercourse or sea? * |
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| Have you or any person living with you had any special terms imposed by an insurer or had insurance cancelled, declined or a renewal declined, been convicted of a criminal offence, received a Police caution or have any prosecutions pending? * |
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Locks |
| 5 lever mortice deadlocks on external doors * |
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| Top and bottom patio door locks |
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| Window locks on accessible windows * |
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Alarm |
| Central Station |
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| RedCare |
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| Dualcom |
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| Subject to a maintenance contract? |
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| Any other security information (e.g. Neighbourhood Watch)? |
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| Claims experience (over last five years), please include date, details and amount of claim |
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| Criminal convictions? * |
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Buildings and Contents Buildings sum insured (optional) |
| Main Building |
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| Domestic outbuildings |
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Contents and Personal Effects |
| General Contents |
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Futher Information |
| Please use this space to give any other information |
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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 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).
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Agreement |
| I have read and agree to the terms and conditions above: * |
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