To obtain a quotation simply complete the form further down this page and click send. If you prefer you can Click here to open a “printer friendly” version.

You can send your printer friendly version back to us in 3 ways:

  • Fax it to us at 01902 710327
  • Post it to us at FREEPOST RRRT-KHXA-BUHT, Residentsline, 29 Waterloo Road, WOLVERHAMPTON, WV1 4DJ.
  • Scan and Email it to us at

Company Name:
Your Name:
Postal Address:
Tel No: (required)
Where did you hear about us?
Renewal Date:
Current Insurer:
Current Premium
Address of Property to be insured:
Description of Property to be insured
Sum Insured:
and (if shown) Declared Value.
No. of buildings:
Age of Property:
No. of flats/residential units:
if converted, when?
No. of storeys:
Does the Property have any flat roofed areas?  Yes No
If yes, when were the covering materials used for the flat roofing last renewed or replaced?
Floors & Stairs:
No. of garages :
Are they in a separate block? Yes No 
Is the Property to be insured listed?

Additional Information
1. Number of Residential Units/Flats which are:

Owner Occupied:
Let under assured short hold tenancy agreement or similar:
Let under other conditions
Additional Comments:
2. Is any part of the property occupied by or let as:
Holiday Homes/Second Homes   Yes No
Bedsits  Yes No
Student Accommodation  Yes No
DSS Tenants  Yes No
Hostels/Homes Used By Local Government or Charitable Organisations  Yes No
If Yes, Number of Flats/Residential Units
3. Is the property in a good state of repair?
 Yes No
4. Is your property currently, or has it ever been affected by subsidence, ground heave, landslip, storm or flood?
 Yes No
5. Is the property currently undergoing renovation, repair conversion, or alteration or is any such work anticipated in the next 12 months?
 Yes No
6. Are there any communal facilities? (lift, boiler, tennis courts, swimming pool etc)
 Yes No
7. Is there any commercial use? (i.e. shops, offices, restaurants)
 Yes No
If the answer to Questions 3,4,5,6 or 7 is “Yes” – Please provide additional details:
8. Have you sustained any losses involving the risks proposed, or had any claim in the last 3 years?
 Yes No
If yes, please provide additional information below:
Additional Covers:

The Residentsline policy automatically provides a comprehensive package of cover including “all risks” cover for buildings, public liability, employer’s liability and optional legal expenses. Please indicate if you would be interested in options to include cover for:
 Yes No
Directors and Officers Liability:
 Yes No
if yes select limit below
 £100,000 £250,000 £500,000 £1,000,000 £2,000,000
Lift Inspection and Machinery Breakdown Insurance:
 Yes No
If Yes, Please confirm number of lifts per building and number of floors