| Name: |
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| Address: |
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| Phone Number (Home): |
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| Phone Number (Work): |
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| E-Mail: |
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| Date of Birth: |
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| Property Information |
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| Address of property to be insured: |
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Type of Property : |
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Is this property |
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Your Main Residence? |
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A Holiday Home? |
Yes
No |
A holiday Home - Let out? |
Yes
No |
Owner occupied? |
Yes
No |
Accommodation rented by you? |
Yes
No |
Rented to tenants? |
Yes
No |
If the property is rented to
tenants, describe the tenants: |
|
Is the house totally of standard construction? i.e. built of brick/stone/concrete & roofed
with slates/tiles. |
Yes
No |
| If the answer is No, state type of construction: |
Walls: |
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Roof: |
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Timberframed: |
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Other: |
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Has any portion of the house a flat roof of mineral felt felt and timber |
Yes
No |
If so, give percentage roofed
like this: |
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Year Built: |
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Number of Bedrooms: |
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Alarm Installed? |
Yes
No |
if so, NSAI approved & fitted? |
Yes
No
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If so, connected to a
central monitoring station? |
Yes
No
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Security locks doors? |
Yes
No |
Security locks/ bolts on windows? |
Yes
No |
Smoke Alarms fitted? |
Yes
No |
If so, how many? |
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Neighbourhood Watch/Community Alert Area? |
Yes
No
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Is the house normally
unoccupied during the day? |
Yes
No |
Is the house normally
unoccupied during the night? |
Yes
No |
| Do you keep paying guests? |
Yes
No |
If so, maximum number at any
one time? |
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Is this done on a seasonal or
year round basis? |
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Is any of the house used
for business purposes? |
Yes
No |
| If so, give details |
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| Cover Required |
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| Please state how much you house and contents are to be insured for: |
| Buildings (€) |
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| Contents (€) |
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| Personal items to be insured away from the home: |
Unspecified valuables under €1000 each, (Personal Possessions you would like to specifically insure outside your home such as sports equipment, jewellery and valuables if they are accidentally lost, destroyed, damaged or stolen) |
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| Specified Valuables over €1,000 each, (Personal Possessions you would like to specifically insure outside your home such as sports equipment, jewellery and valuables if they are accidentally lost, destroyed, damaged or stolen) |
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Any claims made in the
last five years? |
Yes
No |
| If so, give details: |
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If you have motor insurance, what company are you insured with? |
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Who is your present Home Insurance Company? |
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| Renewal date of Existing policy? |
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We maintain a strict
"No Spam" policy. We take great
care with the information provided and will
not share your email address or personal
information with third parties. See our Privacy
Policy.
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