About You:
Title:(Mr, Mrs, Ms, Miss)
Name:
Date of Birth:
Partners Name:
Partner's Date of Birth:
Home Address:
Post Code:
Contact Number:
E-mail Address:
Exact Occupation:
Any Claims in the Last 5 years
(details and dates)
About the Property:
First time Buyer:
Property type:
Detached House
Semi Detached
Flat
Masonette
Approx Year Built:
Number of Bedrooms:
1
2
3
4
5
6
Unoccupied daily:
yes
no
Cover:
Building sum insured:
Cover:
Total Contents within the home:
Valuables included in total above:
(collections, clothing etc within the home)
Cover:
All Risks (outside of the home)
Unspecified items up to the value of £1,000
Sports equipment
Jewellery
Security:
Is security discount required:
yes
no
Approved Burglar Alarm:
yes
no
Neighbourhood Watch:
yes
no
Smoke Detector:
yes
no
Preferred Method of Payment:
Cheque
Credit Card
Direct Debt
© Seico Insurance Consultants 2005
info@seico-insurance.com
