Get A QuoteFor a competitive Insurance quote, please fill in the following form.1 Your Details2 Your History3 Your Property4 Your PreferencesYour DetailsTitle*MrMrsMissMsFirst Name*Surname*Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email Address* Primary Contact Number*Secondary Contact NumberAre you a UK resident?*YesNoIf no, please state residency*Your HistoryHave you, the applicant or any director, trustee, or representative of the organisation seeking insurance:Ever had insurance cancelled, declined or special conditions imposed by any insurer?YesNoEver been convicted of any offence other than a driving offence?YesNoEver been declared bankrupt or been the subject of bankruptcy or insolvency proceedings?YesNoSubject to a County Court Judgement or, in Scotland, Sheriff Court Degree?YesNoEver been prosecuted for failure to comply with any Health and Safety Environmental Protection legislation?YesNoYour PropertyFull name of the insured*Date Cover is Required From* Date Format: DD dash MM dash YYYY Address Line 1*Address Line 2TownCountyPostcode*Property Type*Private Dwelling HousePurpose Built Block of FlatsConverted to FlatsScottish Freehold FlatOfficesCommercialMixed Commercial & ResidentialOtherRebuild cost*Is the property a standard construction built of Brick, Stone, or concrete and roofed with slate, tile, concrete, metal or asbestos?*YesNoIs the property well maintained & in a good state of repair?*YesNoDoes the property have any area that is flat roofed?*YesNoApproximate percentage of the roof area that is flat?*Material of roof?Asphalt on TimberFelt on TimberOtherAge of property?*Floor construction*WoodenConcreteBothNumber of storeys*Number of storeys12345+Is the property a listed building*NoGrade 1 ListedGrade 2 ListedHave you made any claims on the property to be insured in the past three years?*YesNoHas the property to be insured ever been damaged, shown signs of or had repairs in connection with subsidence, heave or landslip?*YesNoTo the best of your knowledge, has the property to be insured ever been the subject of an arson claim?*YesNoOccupancy of the property?* Working tenants Housing Benefit tenants Working Tenants with Benefits Top-Up Retired tenants Students Owner-Occupied Commercial Vacant OtherCurrent insurer?*Current premium*Your PreferencesHow would you like to receive your quote?PhoneEmailBest time to contact?MorningAfternoonEveningAnyHow did you hear about us?Promo code iInsure365 may decide from time to time contact you via email with offers and information that we feel may be of relevance or interest to you. Please tick here if you wish to opt out from this.
