• From what date should your policy commence?*
     / /
  • Date of birth*
     / /
  •  -
  • Is a joint policy required?*
  • Date of birth*
     / /
  • Do you have any lodgers?*
  • Do any others over the age of 16 live at the property?*
  • Date of birth*
     / /
  • Do any others over the age of 16 live at the property?*
  • Date of birth*
     / /
  • Do any others over the age of 16 live at the property?*
  • Date of birth*
     / /
  • Do any others over the age of 16 live at the property?*
  • Date of birth*
     / /
  • Is the property a listed building?*
  • Is the property your permanent residence?*
  • Is the home or land open to the public?*
  • Is there any land at the premises that is over 10 acres for which you would like to insure your legal liability to the public?*
  • Is the home left unoccupied for more than 30 consecutive days?*
  • Does anybody living in the premises smoke?*
  • Type of property?*
  • Type of building?*
  • Is there a smoke alarm fitted in the property?*
  • Do all external doors have 5 lever mortice deadlocks and/or a multi-point locking system?*
  • Are all ground floor and accessible windows secured by key-operated window locks?*
  • If your home is protected by an intruder alarm, please indicate which type:
  • Does your home have a safe?*
  • Has the safe been professionally installed?
  • Is it anchored?
  • Do you have CCTV in operation at the premises?*
  • Do you require cover for your buildings?*
  • Is the home and domestic outbuildings in a good state of repair?
  • Do you require cover for the contents within your property?*
  • Do you require cover for items taken away from the home?*
  • If yes, please select the items which require cover below
  • Do you require cover for fine art and antiques*
  • If yes, are any items worth over £25,000?
  • Do you require family legal protection cover?*
  • Have you ever made a claim under your home insurance?*
  • Please advise the date of the occurence
     - -
  • Have you made any additional claims under your home insurance?
  • Please advise the date of the occurence
     - -
  • Has the home or its domestic outbuildings suffered from flooding within the last 25 years?*
  • Has the home or its domestic outbuildings suffered from or been monitored for subsidence, landslip or heave within the last 25 years?*
  • Are you undertaking or planning any extensions, renovations or structural works to your home within the next 12 months?*
  • In respect of the proposer or any other person to whom this insurance would apply, has any insurer: declined to accept, cancelled or refused to continue the insurance or agreed to continue the insurance only on special terms?*
  • Have you, or any person residing with you, ever been convicted of, or charged with but not yet tried for, any offence other than a driving offence? (subject to the Rehabilitation of Offenders Act 1974)*
  • Have you ever been declared bankrupt, insolvent or been subject to an Individual Voluntary Agreement (IVA)?*
  • Do you wish to pay an additional excess towards each claim? Please note the standard excess is £100.*
  • If yes, please select the additional amount you would like to pay below:
  • Would you like to receive news and updates from Cliverton?*
  • Should be Empty: