Form 2 - Home/ Landlords IDEAL Group

Let's start with some information about your property.
Name of Registered Owner of the property

First Name Last Name
Date of Birth
dd-mm-yyyy
Best number to ring to clarify any responses to the form

Area Code Phone Number

Property Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Age of property in years
When was the property last rewired?
When was the property last re-plumbed?
When was the property last renovated?
Number of members residing at this property

Optional Covers

Accidental Damage cover only - Electrical or Mechanical Breakdown
Do you require Electrical or mechanical breakdown cover for electrical appliances? Note: This is in addition to the burning out of an electric motor.

Yes No

Thanks, we look forward to getting in touch with you!
Lead ID
Should be Empty: