Other Information

TESTFORM

Landing Page Form

"*" indicates required fields

1. YOUR DETAILS

Email*
DD slash MM slash YYYY

2. YOUR INSURANCE DETAILS

DD slash MM slash YYYY
Occupancy*

3. ADDITIONAL DETAILS

Accidental Damage*
Accidental Damage*
Is there a detached garage?
Is there a minimum of two smoke detectors in place (battery or mains)*
Is there any portion of flat roof*
Is there an alarm on the property*
Is the alarm connected to a central monitoring station?*
Are all windows secured with Key locks/Internal Locks*
Are all external doors five point locking mechanism / key operated*
Have you had any property claims in the last 5 years?*
MM slash DD slash YYYY