Property Owners Insurance enquiry - David J Miller Insurance Brokers

Property Owner’s Insurance Enquiry

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Please complete the form below to get a property owner insurance quote. It shouldn't take you longer than 5 minutes.

CONTACT DETAILS
Contact name:

Telephone number (mobile):

Telephone number (landline):

Email address:

Policy due date:

Current insurance held with:

Current insurance premium:

Have you had any claims in the last 5 years?:

If yes - please specify dates, incidents and amounts here:

Insured name:

Correspondence address:

Town:

Postcode (required):

PROPERTY DETAILS
Property risk address:

Town:

Postcode:

Date property purchased:

Property type:

If other - please specify:

Occupancy trade description:

Is the property occupied?

Sums insured (reinstatement values)

Buildings:

Landlord contents:

Glass:

Loss of rental income per annum:

Loss of rental income indemnity period required?:

Property owners liability:

Do you require subsidence cover?:

Do you require accidental damage cover?:

Do you require legal expenses cover?:

Property type:

Number of storeys:

Are your premises all of standard combustible construction ie. Walls constructed from brick, stone, or concrete and roofs of slate, tile, concrete, metal or abestos?

If 'No' - please provide full details of the materials used in the construction of your premises (Walls, Roof and Floor):

Is any part of the roof flat or felt on timber construction?

If 'Yes'- what percentage?:

Are there any pre-fabricated insulation panels, composite panels or wall linings of any description used in the construction of the premises including external cladding?

If 'Yes' - please provide a full description of their type (insulation material), location, % of total construction and age:

Is the building grade listed or subject to an building preservation order?

If 'Yes'- please provide the building grade:

Are the premises heated solely by means of fixed hot water central heating systems, mains electricity or mains gas?

If 'No' - please provide heating method:

Are there any adjoining buildings/properties?

If 'Yes' please advise neighboring trade type(s) AND whether they are separated by a fire break wall:

Has the property ever suffered from flooding?

SECURITY DETAILS - under YOUR control
Does the premise have an intruder alarm?

Is the alarm annually maintained under contract by a NSI(NACOSS)/SSAIB accredited firm?

Does the alarm have police response?

Does the premise have CCTV?

Does the premise have roller shutter/grills to doors and/or windows?:

Does the premise have 24 hour on-site security?

Does the premise have a fire alarm (integrated mains wired alarm)?

If 'yes'- is the fire alarm connected to a central station or the fire brigade?

Is there a sprinkler system?

Any other notes:

DECLARATION
You or any director or partner in any business, any partner in any partnership, any director of any company, or the company;
either in any personal capacity, in the name of the business proposed or in respect of any other business in which any of you have ever had an interest have:

- Never had a proposal for insurance declined, cancelled or refused?
- Never had insurance cancelled mid-term, a renewal refused, increased or special terms or conditions imposed by an insurer?
- Never been given an official police caution, convicted of, charged (but not yet tried) or have any prosecution pending for any offence (excluding any motoring convictions and any offences which are spent under the Rehabilitation of Offenders Act 1974)?
- Never been the subject of or issued with a County Court Judgement (CCJ), money judgement or court decree and/or ever been cited in any unsatisfied court judgements (or the Scottish equivalent) or any other judgements or decrees in relation to debt?
- Never been declared bankrupt or insolvent, the subject of an individual voluntary arrangement (IVA) or company voluntary arrangement (CVA) with creditors, voluntary liquidation, a winding up or administration order, or administrative receivership proceedings, bankruptcy or insolvency proceedings?
- Never been disqualified from being a company director?
- Never been censured by any regulatory or trade body or any action been taken against the company by the office of fair trading, consumer groups or the alike?
- Never been served under any Health & Safety, Welfare, Environmental, Consumer Protection or Food Safety legislation or any other legislation, with any warnings, enforcement measures, prohibition notice, improvement orders, proceedings or criminal proceedings by any Health and Safety Executive, Environmental Health Office, Environment Agency, local or government authority or any other enforcement agency or authority?
- Never been convicted of, charged (but not yet tried) with, officially cautioned or have any prosecution pending for a breach of any Health & Safety, Welfare, Environmental, Consumer Protection, Food Safety legislation or any other legislation?
- Never been the subject of a recovery action by Customs and Excise or the Inland Revenue?

Please confirm if you agree with the declaration(*)?:

If you do not agree with the declaration- please advise why here:

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