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Please enter the details of the person you would like us to contact with your quote.
Title
First Name
Middle Initial Last Name
Organisation Address
City Post Code
Work Phone FAX
E-mail    
 

Please provide the address of the property to be insured (including the post code)
Does the property have any living accommodation?  Yes No
If Yes, please select the answer which best describes how it is occupied:
A. Professional Lets
B. Unoccupied
C. Student Lets
D. DSS Lets
E. Owner Occupied
F. Other 
(if so, please specify): 
What type of business was last traded on the premises?  
Do you intend to refurbish the property in the near future? Yes No If Yes, please provide details:
Please state fully what your intentions for this property are:
Please indicate when you would like cover to begin (Start Date): Please indicate the Buildings Sum to be insured:
Please state any mortgage or any other Financial Institution that requires to be named on the Policy:
Is the property built of standard construction (i.e. brick, stone or concrete and roofed with slate, tiles, concrete or asphalt)? Yes No
If No, please provide details:
Is the property in good state of repair and be maintained as such?  Yes No If No, please provide details:
Is the property free from flooding and not in an area susceptible to flooding?  Yes No If No, please provide details:
Is the property free from signs of damage due to subsidence, landslip or heave and not in an area where there has been, or is evidence of these causes: Yes No If No, please provide details:
Has any insurer declined to accept, cancelled, refused to continue or agreed to continue only on special terms, any insurance for the proposer or any other person to whom this insurance would apply: Yes No If Yes, please provide details:
Has anyone tried to gain entry to the property or vandalised it (including graffiti) in the last 5 years? Yes No If Yes, please provide details:
Have you or any other person whose property is to be insured hereunder sustained any loss or damage in the last five years which would have been covered by this type of insurance had it been in force, whether or not a claim was paid? Yes No If Yes, please provide full details including dates and amount paid if any:
Have you or any person residing with you ever been convicted of arson or any criminal offence? Yes No If Yes, please provide details:
       
Current Insurer?
Expiry Date?
How long have you owned the property for?
 

 

     insurance intermediary

OUR CONTACT DETAILS

Andrew Copeland
Insurance Consultants Ltd
230/234 Portland Road,
London SE25 4SL
Tel: 020 8656 2544
Fax: 020 8655 1271
info@acopeland.com

INSURANCE SPECIALISTS
Insurance Specialists
With years of experience behind us, Andrew Copeland Insurance Consultants Ltd are your one stop shop for property insurance.

 
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