*mandatory fields
Part 1 : Your information
Name of management company or individual *
Contact name*
Telephone number (Day)*
Telephone number (Evening)
Email address*
Property address 1
Property address 2
Property address 3
Property city
Property postcode
Renewal date (dd/mm/yy)*
Part 2 : About the property
Is your property purpose built?
Yes No
Is your property converted?
Yes
No
Age of building
Is your building listed?
Yes No
If your building is listed, what type is it?
Please select
Grade 1
Grade 2
Grade 2*
Number of flats
Number of storeys
Number of flats owner occupied
Number of flats let
Are any flats let to students, DSS or asylum seekers?
Yes
No
Construction walls
Please select
Brick
Stone
Concrete
mixed construction
If mixed construction, please indicate the materials used, along with the appropriate approximate percentages of use. Percentages should total 100%.
Floor
Please select
Timber
Concrete
mixed construction
If mixed construction, please indicate the materials used, along with the appropriate approximate percentages of use. Percentages should total 100%.
Roof
Please select
Slate / Tile
Felt / Asphelt (Timber base)
Felt / Asphelt (Concrete base)
mixed construction
If mixed construction, please indicate the materials used, along with the appropriate approximate percentages of use. Percentages should total 100%.
Any evidence or history of subsidence, heave or landslip?
Yes
No
Ever suffered from flooding or is there a history of flooding in the area?
Yes
No
Building reinstatement value
Part 3 : Current Insurance Details
Current insurer
Present premium
Have you had a claim in the last three years?
Yes
No
Details of any claims in the last three years (please include date, circumstances and amount(s) claimed)