Inception Date or Renewal Date of your current policy -

Your Full Name/Limited Company Name If have one?

Contact Number & Email address

Correspondence address -

Address of the property to be insured -

What tenant type occupies the premises? If more than one please specify -

Is the property Multiple Tenure?

In the property maintained in a good state of repair?

Is the property heated solely by electricity and/or mains gas, and/or solid fuel, and/or oil-fired central heating (No LPG)? Please specify.

Is there any open fires or solid fuel stoves at the property?

Is the property in an area which to your knowledge has not been subject to flooding and is at least 250 metres away from the nearest lake, river, canal or tidal water?

Has/Have the property(s) ever been subject, to your knowledge, to any subsidence, landslip, ground heave or ever been underpinned?

The premises are not being monitored (or have ever been monitored) for Subsidence, Ground Heave or Landslide? The premises do not have trees or shrubs of heights over 5 meters within 7 meters of the Buildings?

Are there plans to undertake within the next 12 months or are the building(s) currently undergoing any form of building work or construction or alteration?
Is any structural work going to be undertaken? Please provide full details of the plans for the building and how long any work will take to complete.

The premises have never been subject to a survey which mentions Settlement or Movement of Buildings?

The premises have never flooded as a result of broken or damaged drains underground drains and you are not aware of any extensive underground draining problems?

Building Rebuild Amount –

Annual Loss of Rent - Indemnity Period?

Any Landlords Contents -

Wall construction-

Roof Type (% flat or pitched etc)

Roof Construction (Tile, slate, concrete etc)

Year built-

Is any portion of the building unoccupied/ going to be unoccupied in the near future?
If Yes, please provide details of how long you expect the premises to be unoccupied for and if the premises will be checked etc.

Any flats on site?

What is the Residential Tenant Type within the property(s)?

Is/Are the lease agreement(s) held directly between the freeholder/agent and the tenant?

Is the lease agreement in place for a minimum of 6 months?

Does the lease agreement(s) allow your tenants to sub-let within the premises?

Number of years owned the property?

Is the property classed as a Home of Multiple Occupation or Large Home of Multiple Occupation under Housing Act legislation?

Confirm you meet all statutory obligations including fire safety, electrical inspections, Health & Safety and COSHH regulations relating to the business and have in place a current Fire Certificate and a current Electrical Inspection Certificate?

Public Liability Sum Insured: 2M,5M or 10M

Numbers of years as a landlord?

Any claims in the last 5 years?
Please provide full details including date, what happened, measures taken.

Any CCJ’s, liquidations, convictions, or bankruptcy?

Current Insurer/ Target Premium

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