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Personal Details
Contact Name	*
Policyholder's name, if different (i.e. Management committee)
Correspondence Address
Post Code
Telephone	*
Email address	*
Property Details
Premises Address	*
Premises Post Code	*
Sums Insured
Buildings	*
Day 1 inflation protection	0% 15% 30% 50%
Annual rent / cost of alternate accommodation
Rent period of indemnity	12 Months 24 Months 36 Months 48 Months
Property owners liability	£1,000,000 £2,000,000 £5,000,000 Not Required
Contents of communal areas
Options
Perils	All Risks Fire, Perils and Subsidence Fire and Perils Fire, Lightning, Aircraft & Explosion
Terrorism cover
Legionellosis extension
Employers liability
Employers liability details (list occupations and wage roll)
Constructions and Risk Details
Year built (approximate)	*
Purpose built?	Yes  No
If 'No' Year converted
Concrete floors?	Timber Stone Concrete
Concrete stairs?	Timber Stone Concrete Not Applicable
Construction walls	Brick Stone Concrete block Composite panels Composite panels (mineral wool) Part Brick/ Concrete/ Steel Timber
Construction roof	Tile Slate Corrugated Concrete/ Asbestos Steel Timber Thatch Flat felt Flat concrete Pitched felt
Proportion flat roof	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
CCTV Cameras?	Yes No
Entry phone?	Yes No
Neighbourhood watch?	Yes No
Is electrical wiring system checked annually?	Yes No
Maintained fire alarm?	Yes No
Number of storeys	*
Number of flats
Type of occupancy (click all that apply)	Owner occupied
	Let to working people
	Let to students
	Let to DSS/ housing benefits
	Let to asylum seekers
	Part unoccupied 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Past Experience
Number of years owned	*
Current insurers	*
Renewal premium	*
Renewal/ deadline date	*
Claims in last 5 years - provide circumstances, date and amount (if none - state)
Additional Information
Please list any other information which may influence the underwriters quotation
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