Get A Quote » Brickman Yale − Chartered Surveyors • Property Management

1. Contact Name *

2. Address *

3. Post Code *

4. Telephone *

5. Email address *

6. Name of Insured *

7. Risk Address *

8. Post Code *

9. Note of Interest (Mortgage / Building Society to be noted on policy)

10. Building Re instatement Value *

11. Total loss of rent to be covered *

0 months

12 months

24 months

36 months

12. Inception date *

13a. Is the property built of standard construction (e.g. Brick/Stone walls with Slate or Tiles Roof) *

Yes (go to question 14)

No (please complete construction details)

Other (please complete construction details)

13b. If 'No' or 'Other' please give construction details

14. If the property is a block of flats, are the floors made of timber? *

Yes

No

N/A

15a. Is any part of the property let to a Housing Association or DSS tenant?

Yes (please add a percentage below)

No (go to question 16)

15b. What percentage of the property does this represent?

16a. Is the property listed? *

Yes (please give grade)

No (go to question 17)

16b. If 'Yes' please give grade

17a. Are the premises occupied? *

Yes (go to question 18)

No (since when has the property been unoccupied)

17b. If 'No', since when has the property been unoccupied?

17c. When will the property be occupied and by whom?

18. Use / Intended use of the premises (e.g. Newsagent with private accommodation above) *

19a. Have you had any claims or losses in the last 5 years? *

Yes (please provide details below)

No (go to question 20)

19b. If 'Yes', give details of claims or losses in the last 5 years

20. Has the property suffered from any subsidence landslip or heave?

Yes

No

21. Are there any signs of cracks in the property? *

Yes

No

22a. Has the property been underpinned?

Yes (please state when below)

No (go to question 23)

22b. When was the property underpinned?

23. Do you require terrorism cover? *

Yes

No

24. I/We declare that the answers given are true and complete to the best of my/our knowledge and belief and that any material fact, which may influence the company has been disclosed. I/We understand that if true answers are not given that this insurance *

I agree