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Residentsline Buildings Insurance Quotation Form

To obtain a quotation simply complete the form further down this page
or
Click here to open a "printer friendly" copy of the form
which you can print, complete and fax back to us on 01902 710327
or post to us at:
FREEPOST RRRT-KHXA-BUHT, Residentsline, 29 Waterloo Road,
WOLVERHAMPTON, WV1 4DJ

Company Name:
Your Name:
Position:
Email:
Postal Address:
Postcode
Tel No:

Renewal Date:
Current Insurer
Sum Insured		and (if shown) Declared Value.
Address of Building(s):
Age:		if converted, when?
No. of flats :		No. of storeys :
CONSTRUCTION
Walls :		Roof:
Floors & Stairs :

1. Is the property to be insured:
a. purpose built flats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	YES NO

b. a private dwelling converted into flats. . . . . . . . . . . . . . . . . . .	YES NO

c. Other, please describe:

d. In a good state of repair and occupied solely as private residences NOT being: i. Holiday homes? ii. Bedsits/student accommodation? iii. Hostel and/or used as homes by the local government or Charitable Organisations?	YES NO *

e) is your property currently, or has it ever been affected by subsidence, ground heave, landslip, storm or flood?	YES * NO

f) currently undergoing renovation, repair conversion, or alteration or is any such work anticipated in the next 12 months?	YES * NO

2) Are there any communal facilities? (lift, boiler, tennis courts, swimming pool etc)	YES * NO


3) Is there any commercial use? (i.e. shops, offices, restaurants)	YES * NO

4) Have you ever been refused insurance or had special terms/conditions imposed?	YES * NO

5) Have you sustained any losses involving the risks proposed, or had any claim in the last 3 years?	YES * NO

Additional information (to where answers given are marked with an asterisk *)

Our Residentsline policy underwritten by Norwich Union provides cover on an “All Risks” basis and automatically includes Alternative Accommodation/Rent, Public Liability, Employers Liability, Glass and Money extensions. In addition, we offer:

	A dedicated 24 hour Claims Line

	Emergency help 24 hours a day

	Legal advice and assistance (up to £50,000 legal costs)

	Interest free monthly premium payment facilities

If we consider that Norwich Union is unsuitable or uncompetitive, based on the information you have provided, we will endeavour to offer a quotation from another insurer.

Residentsline also represents Allianz Insurance, AXA UK, Royal & SunAlliance and Zurich UK.

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