Home Insurance Questionnaire

Please ensure that all questions are answered fully, truthfully and accurately as these details will be provided to insurers and will be used to provide insurance terms. Non-disclosure of any relevant information may result in the non-payment of future claims. If you are unsure about any of the questions, please call us on 01624 654000.

Applicant Details

Date of Birth*

Smoker?

Date of Birth

Smoker?

Are you IOM resident, aged 18 years or over?

Have you ever had insurance declined or had special terms imposed?

Have you, or anyone normally resident with you, ever been convicted of a criminal offence (non-motor)?

Have you, or anyone normally resident with you, ever been declared bankrupt?

Are you, or anyone in your household, a Politically Exposed Person? ?

Is your home used for any business purposes?

Is this a holiday home?

Is the insured property your main residence lived in by you & your family and fully furnished?

Is the property left unoccupied for more than 30 consecutive days?

Is the property a listed building or in a conservation area?

Number of occupants
Which of the following describes you property?

Property Details

Is the property self-contained with a lockable front door under your control?

Are all exit doors fitted with 5 lever mortice deadlocks or Yale multi-locking system?

Are all windows lockable?

Smoke Detectors?

How is it powered?

Is the property free from flooding, subsidence, landslip or coastal erosion and ground heave?

Is the property in a good state of repair?

Is the property close to a river, watercourse or the seafront?

Is the property near to a mine or quarry?

Cover Details

£
(amend if greater)
Accidental Damage
£
(amend if greater)
Accidental Damage

Do you require cover for personal possessions outside of the home?

£
(amend if greater)

Do you wish to cover any specified items with an individual value greater than £2,000

Do you require Legal Expenses cover?

Have you made any insurance claims in the last 5 years?

Please include date, type of claim, whether the claim has been settled and the settlement amount

No Claims Years

Current Insurer