Household Insurance Proposal

Is your home:

Standard construction, built of brick, or stone with slate or tiled roof?
YesNo
Used as a private dwelling, and not for business purposes?
YesNo
Close to any cliffs, quarries, or excavations?
YesNo
Close to any rivers, seas, or in an area prone to flooding?
YesNo

Has your home, or any nearby:

Been damaged by subsidence, heave or landslip?
YesNo
Shown any signs of cracking, or bulging or even been underpinned?
YesNo

Have you or any member of your hosehold:

Suffered any claims or losses in the last three years, including legal expenses claims ?
YesNo
Had any criminal convictions/ cautions, including pending convictions/cautions
YesNo
Been refused or declined insurance, or had special terms imposed, or had a policy cancelled?
YesNo

Is your home:

Owned by you ?
YesNo
Normally occupied, other than working hours, and holidays of less than 60 days
YesNo
Occupied by you and family membersonly, and not rented out, let or sublet
YesNo

Buildings -- this should represnt the full re-building cost as new plus an allowance for professional fees and removal of debris following a loss.

Accidental Damage YesNo

Contents - This should represent the full replacement cost of the contents.

Accidental Damage YesNo

Valuables - Personal Possessions.

Accidental Damage YesNo
I hereby declare that to the best of my knowledge and belief the above statements and particulars are true and correct and that i have withheld no information material to Proposal whether the subject of a Proposal Form question or not. I understand that failure to disclose all facts known to me which would be considered by the insurer as likely to influence the acceptance and assessment of the Proposal could render the subsequent Policy inoperative. (NOTE - Where there is any doubt whether facts would be considered material those facts should be disclosed). I agree that this Proposal and Declaration shall form the basis of the contract between me and the insurer.