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Home Insurance Quote/Renewal Enquiry Form


If you have recently had an alarm installed, or your current security arrangements upgraded, and the installer has referred you to us, you will receive an introductory 5% discount off your home insurance premium with us.  Please complete the relevant fields below to advise whom carried out the work and referred you.

Name of security installer whom referred you :
Type of alarm or security system fitted at the insured address :
Date of installtion :

About you and your current insurance :-
Name* : A value is required.
Address
(to be insured):
Town/City :
County/District :
Postcode :
Daytime telephone* : A value is required.
Email* : A value is required.Invalid format.
Date of Birth* : A value is required.Format: dd/mm/yyyy Current Occupation :
Present Insurer : Renewal Due : Format: dd/mm/yyyy Premium : £ 

Buildings:-
Is cover required for buildings : Cover required : Accidental Damage
      Subsidence
Type of property :  
Flat roof of more than 20% of total roof area :
Year property built :     Number of bedrooms :
Sum insured/re-building cost : £  (Minimum £75,000)

Contents :-
Is cover required for contents : Cover required : Accidental Damage
General contents sum insured : £  (Minimum £15,000)

Personal Possesions in or away from the home (e.g. cameras, laptop computers etc.)
Unspecified : £  Specified : £ 
For all items with an individual value not exceeding £1000 For all items with an individual value exceeding £1000
Pedal Cycles : £  Other : £ 

Jewellery in or away from the home
Unspecified : £  Specified : £ 
For all items with an individual value not exceeding £1000 For all items with an individual value exceeding £1000

Fine Art, Gold/Silver Plate, Collectibles
Unspecified : £  Specified : £ 
For all items with an individual value not exceeding £1000 For all items with an individual value exceeding £1000

Business Contents & Stock
Do you use your home for trade or business purposes :
Business Contents : £  Business Stock : £ 
Contents, tools or equipment of any kind in or away from the home : £ 
Business Cash : £  Business Interuption : £ 
(Includes personal injury following assault)      
Public Liability : £  Employer's Liability : £ 
No. of staff employed :        

Important:

We have made various assumptions on your behalf in order to make this application as brief as possible; please click the Yes or No option against the list below. We will, in most cases, still be able to offer a quotation if you are unable to agree to some of these assumptions. If this is the case please click the relevany No option below and we will contact you to discuss your exact requirements.

1. The property is your main residence and is fully occupied by yourself and your family.
2. The property is of standard construction (ie brick, stone, tile, slate etc.) and is not thatched or listed.
3. The property is not situated within 250m of any stream, river, tidal water, cliff or quarry.
4. The property has no history of subsidence, landslip or heave.
5. The property has a minimum of 5 lever mortice deadlocks fitted on all external doors.
6. The applicant/s have had no previous convictions for theft and/or fraud.
7. The applicant/s have not had any special terms conditions or increased excesses imposed by any previous insurers.
8. The applicant(s) have not made any claims within the last 5 years.
*Compulsory fields

SISS Insurance will not share the information above outside of Apex Insurance Services Limited and the details will only be used for the purposes of providing a fully tailored household insurance quote. Please indicate below if you DO want to receive any future correspondence or information on new products, special offers and updates from SISS Insurance/Apex Insurance Services Limited.





I confirm that the information provided above is accurate and correct: Please confirm.