• Duty of disclosure of Material Facts (Duty of Presentation)

    A material fact is an important fact about you or your circumstances. Fair presentation means that you must have disclosed all material facts, matters and circumstances which you know, which could influence an insurer's or underwriter's decision to accept your insurance. This also applies to facts that you ought to know. You must disclose sufficient information to make the insurers aware that they need to make further enquiries. They can then choose to accept or decline your insurance. If they accept, they may apply certain terms. The duty of fair presentation is a significant obligation placed upon you under the contract of insurance. If you fail to meet this obligation, insurers can take various actions in accordance with the Insurance Act 2015.

  • What you will need to complete the form

  • Please have the following ready in order to complete the form: 

    • Details of your current insurer if applicable
    • Renewal date of current insurance
    • Year the property was built 
    • Construction of the property 
    • Rebuild value of the property
    • Replacement value of any contents to be insured
    • Details of any external door locks
    • Details of any intruder alarm fitted 
    • Details of any claims made in the last 5 years including: date of claim, nature of claim and any payments made. 

     

  • 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?*

  • Data Protection Act

    By accepting your insurance policy, you consent to us using the information we hold about you for the purposes of providing insurance and handling claims. This may involve processing sensitive personal data about you where it is necessary (for example health information or criminal convictions). This may mean we have to give some details to third parties involved in providing insurance cover. These may include insurance carriers, third party claims adjusters, fraud detection and prevention services, reinsurance companies and insurance regulatory authorities. Where such personal information relates to anyone other than you, you must obtain the explicit consent of the person to whom the information relates. This consent must cover both the disclosure of such information to us and its use by us as set out above. The information provided will be treated in accordance with the UK Data Protection Act 2018. You have the right to apply for a copy of your information (for which we may charge a small fee) and to have any inaccuracies corrected.

  • Declaration

    By signing this document you are confirming that all the information provided is correct and true. If any of the information within the documents provided is incorrect, you must advise us as soon as possible. We reserve the right to change the terms and conditions, premium, or withdraw this quotation if any information changes or is found to be incorrect.
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