Landlords Insurance - Quotation Form

To obtain your quotation please submit the on-line form below * = required field

To speak to an advisor phone 01332 299285

1. Landlord Contact Information

Name: * Occupation: Address : Town: County: Postcode:* Telephone: * Fax: E-mail: *

2. How many premises do you wish to insure (up to a maximum of 6)?

Number of premises

3. Property Information (please complete for each property)

Property 1

Address and Insurance details

Premises Address Unit Number / Building Name & Address Post Code* Buildings Sum Insured Contents Sum Insured Tenants a. Working Tenants (in full or part time employment and not entitled to or receiving housing benefits) Yes No b. Students Tenants (in full or part time education and not entitled to or receiving unemployment benefit) Yes No c. Tenants on unemployment, housing or disability benefit but whose tenancy agreement is directly between them and the landlord/agent Yes No d. Tenants on unemployment, housing or disability benefit whose tenancy agreement is not directly between them and the landlord/agent Yes No e. Tenants seeking refugee status under national or international law. (i.e. 'Asylum seekers') Yes No f. Retail / Office tenants Yes No Are the premises currently unoccupied? Property 1 Yes No

Property 2

Address and Insurance details

Unit Number / Building Name & Address Post Code Buildings Sum Insured Contents Sum Insured Tenants a. Working Tenants (in full or part time employment and not entitled to or receiving housing benefits) Yes No b. Students Tenants (in full or part time education and not entitled to or receiving unemployment benefit) Yes No c. Tenants on unemployment, housing or disability benefit but whose tenancy agreement is directly between them and the landlord/agent Yes No d. Tenants on unemployment, housing or disability benefit whose tenancy agreement is not directly between them and the landlord/agent Yes No e. Tenants seeking refugee status under national or international law. (i.e. 'Asylum seekers') Yes No f. Retail / Office tenants Yes No Are the premises currently unoccupied? Property 2 Yes No

Property 3

Address and Insurance details

Unit Number / Building Name & Address Post Code Buildings Sum Insured Contents Sum Insured Tenants a. Working Tenants (in full or part time employment and not entitled to or receiving housing benefits) Yes No b. Students Tenants (in full or part time education and not entitled to or receiving unemployment benefit) Yes No c. Tenants on unemployment, housing or disability benefit but whose tenancy agreement is directly between them and the landlord/agent Yes No d. Tenants on unemployment, housing or disability benefit whose tenancy agreement is not directly between them and the landlord/agent Yes No e. Tenants seeking refugee status under national or international law. (i.e. 'Asylum seekers') Yes No f. Retail / Office tenants Yes No Are the premises currently unoccupied? Property 3 Yes No

Property 4

Address and Insurance details

Unit Number / Building Name & Address Post Code Buildings Sum Insured Contents Sum Insured Tenants a. Working Tenant (in full or part time employment and not entitled to or receiving housing benefits) Yes No b. Students Tenants (in full or part time education and not entitled to or receiving unemployment benefit) Yes No c. Tenants on unemployment, housing or disability benefit but whose tenancy agreement is directly between them and the landlord/agent Yes No d. Tenants on unemployment, housing or disability benefit whose tenancy agreement is not directly between them and the landlord/agent Yes No e. Tenants seeking refugee status under national or international law. (i.e. 'Asylum seekers') Yes No f. Retail / Office tenants Yes No Are the premises currently unoccupied? Property 4 Yes No

Property 5

Address and Insurance details

Unit Number / Building Name & Address Post Code Buildings Sum Insured Contents Sum Insured Tenants a. Working Tenants (in full or part time employment and not entitled to or receiving housing benefits) Yes No b. Students Tenants (in full or part time education and not entitled to or receiving unemployment benefit) Yes No c. Tenants on unemployment, housing or disability benefit but whose tenancy agreement is directly between them and the landlord/agent Yes No d. Tenants on unemployment, housing or disability benefit whose tenancy agreement is not directly between them and the landlord/agent Yes No e. Tenants seeking refugee status under national or international law. (i.e. 'Asylum seekers') Yes No f. Retail / Office tenants Yes No Are the premises currently unoccupied? Property 5 Yes No

Property 6

Address and Insurance details

Unit Number / Building Name & Address Post Code Buildings Sum Insured Contents Sum Insured Tenants a. Working Tenants (in full or part time employment and not entitled to or receiving housing benefits) Yes No b. Students Tenants (in full or part time education and not entitled to or receiving unemployment benefit) Yes No c. Tenants on unemployment, housing or disability benefit but whose tenancy agreement is directly between them and the landlord/agent Yes No d. Tenants on unemployment, housing or disability benefit whose tenancy agreement is not directly between them and the landlord/agent Yes No e. Tenants seeking refugee status under national or international law. (i.e. 'Asylum seekers') Yes No f. Retail / Office tenants Yes No Are the premises currently unoccupied? Property 6 Yes No

4. Is cover required for:

Employers' Liability (Indemnity Limit £10,000,000) Yes No

N.B.

Cover is only provided in your capacity as owner of the Premises and not in respect of any other activities (e.g. as a contractor undertaking refurbishment of the premises or as a business operating from the premises

If you experience problems with the on-line quotation form please contact us

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