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  Residential Let / Vacant Property Quotation Request Form

fields marked with * are required    
*  Your Name :
*  Your Email Address :
* Telephone :
     
* Name of Proposer 1 :
*  DOB for Proposer 1 : day: month: year:
*  Occupation of Proposer 1 :
     
*  Name of Proposer 2 :
*  DOB for Proposer 2 : day: month: year:
*  Occupation of Proposer 2 :
     
*  Risk Address :
*  Risk Postcode :
*  Building Sum Insured :
*  Contents Sum Insured :
     
Year Built :
Listed :
*  Property Type :
*  Number of Storeys :
     
Total number of flats in whole building (if flats) :
Total number of flats to insure (if flats) :
     
If not standard construction please state type :
Flat Roof Area (If Applicable) :
     
*  The Property is Currently :
If let / to be let then written tenancy agreement is / will be more than 6 months : Yes No
If let / to be let then the landlord's agreement is / will be direct with :
If let / to be let then the tenant(s) are / will be :
If let / to be let then then what number of single unrelated persons are there / will there be :
If let / to be let then the tenant(s) are / will be :
     
Have you made a claim in the last 5 years : Yes No
Current Insurers Name :
Current Policy Expiration Date :
Any other information :
     
 


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