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Abbeygate Worldwide Home Insurance Scheme
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Details of Proposer & Owner
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Name
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Date of Birth
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Address
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(city)
(province)
(postcode)
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Telephone
Email
Nationality
NIE/Passport
Occupation
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Details of Property to be Insured
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Address
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As Above
(city)
(province)
(postcode)
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Property Use
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Property Type
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Location
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County
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Do you already have a policy with us ?
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Sums Assured
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Currency
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Main Building Sum Assured
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Outbuildings & permanent structures
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Include Accidental Damage cover on buildings ?
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Contents Sum Assured
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Outside Items
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Include Accidental Damage cover on contents ?
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Liability Cover
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Liability Cover for Domestic Staff
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Excess Amount
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Statement of Fact
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Claims History
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I/we have sustained loss or damage at the property to be insured (for any of the covers requested) during the last five years whether claimed under our insurance policy or not.
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Yes No
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Construction and use. Are the premises (Including outbuildings)...
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built of brick, stone or concrete and roofed with slate, tile or concrete?
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Yes No
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in an area which is free from flooding and not in the vicinity of any rivers, streams or tidal waters?
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Yes No
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Are all the buildings free from cracks and free from signs of subsidence, landslip or heave and as far as you are aware never been monitored for or damaged by subsidence, landslip or heave and not in an area where there is subsidence, landslip or heave?
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Yes No
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left unoccupied for more than 12 consecutive months, awaiting sale or being renovated?
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Yes No
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used for any business or professional purposes other than the letting of your home?
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Yes No
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is the property listed?
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Yes No
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Security
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Are all final exit doors fitted with locks, and all accessible patio doors, French windows, windows, fanlights and skylights fitted with locks, bars or shutters?
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Yes No
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Previous History
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Has any insurer declined to accept, cancelled, refused to continue or agreed to continue only on special terms any insurance for you or any other person to whom this insurance would apply?
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Yes No
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Have you or any other person residing with you, ever been convicted of arson or any offence involving dishonesty, e.g. fraud, theft or handling stolen goods?
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Yes No
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Are you bankrupt or have you entered into an arrangement with creditors?
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Yes No
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Premium
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Total Premium (Including Tax)
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