Mayfair Online - Insurance Consultants

22 Dec 11

Autosport International
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Contact Information

How did you hear about us

Firstname:

Surname:

Home Post Code:

House Number:

Road Name:

Home Telephone No.:

Mobile Telephone Number:

Email Address:

Subsidence

On what type of subsoil is the property built?:

Slopes

Is the property situated on a slope ?

If applicable, please provide further information on the direction and angle of the slope?

Trees & Hedges

Are there any trees or hedges within, or forming a boundary to, the gardens of the property ?

Please describe the vegetation (ie type, height, maturity, condition & distance

History

Is there a history of subsidence, landslip, heave or mining within the property or the neighbourhood of the property ?

Please provide details of circumstances, dates , expected cause, severity etc

Is the property underpinned ?

History

Please provide details of circumstances, dates , expected cause, severity etc

Further Information

Please give further information on any other defences carried out to protect the property against any perils mentioned abouve (ie tree removal etc)

Property Details

Risk Post Code:

Year Built:

Bedrooms:

Property Type:

Extended:

Walls:

Roof:

Listed:

Other Info:

Use / Occupancy

Type of Accommodation:

Residential Status:

Main Residence:

Unoccupied over 30 days consecutively:

Business Use:

Number of Adult Occupants:

Security

Self Contained / Lockable Entrance:

External Door Locks fitted:

Lockable Accessible Windows:

Is a smoke alarm fitted:

Is an intruder alarm fitted:

Buildings Cover

Buildings Cover Required:

Buildings Level of cover:

Building Sum Insured

Building Sum Insured:

No Claims Discount:

Interested Party:

Contents Cover

Contents Cover Required:

Contents Level of Cover:

Contents Sum Insured:

No Claims Discount:

Highest value item in the home:

Possesions & Specified Items

Specified Items

Jewellery / Watches: Total value:

Paintings & Other Art: Total value:

Fur: Total value:

Antiques & Antique Furniture: Total value:

Statues: Total value:

Collections: Total value:

Cover Away from the home

Unspecified Possessions

Cover Required:

Total Sum Insured:

Territory::

Specified Possessions

Single Items valued £1500+: Total value:

Sports Equipment: Total value:

Photographic Equipment: Total value:

Bicycles: Total value:

Policy Holder Details, Claims and Submit

Date of Birth:

Marital Status:

Uk Resident (Years):

Occupation:

Employers Industry:

Full time / Part Time:

No of vehicles at home:

Motor Renewal Month:

Claims

Number of claims:

Claim Type:

Date:

Cost:

Cover & Submit

Cover Date:

Best Quote:

Include Legal Expenses:

Include Travel Insurance:

Include Breakdown Insurance: