building & Public
property landlord
Quotations

  landlord Insurance Quotation
( Saving Pounds )
FROM:

 

Your name
Your contact telephone / mobile ( Mobile if Possible Please )
Your E-Mail address
 
Proposer Details - We regret we cannot quote for Northern Ireland
Your First Name
Your Last Name 
1'st line Home address
2'nd line Home address
Town / City
UK County
Full Post Code
Years lived in UK
Homeowner Yes/No

Married Yes/No

Date of Birth

building or Public property

Cover Required

Please give the Date cover required from.

( Start date needed for accurate quote ) 

landlord Base post code. first part only needed

   e.g. BB12

Licensing Authority

 ( e.g. Calderdale, City of York, London,Harrow )
 

Vehicle Details
Vehicle Make, ie, Ford
Model, ie,  Mondeo
Model, ie, GLX or SRi
Engine Size,cc

Petrol or Diesel

Vehicle Value

How many Seats including driver in total

Year of Manufacture

Number of years you have owned this vehicle

Modified - Yes/No?

 Yes or No
 
Details of All Drivers - All Drivers Must be Aged 25 or over ( MAX 2 DRIVERS )

  list all drivers inclusive of yourself
Name

Date
Of
Birth

Yrs UK driving licence

Yrs landlord Licence

Occupation if not landlord driver

 Annual
Mileage
1       policyholder
2
4  Any Disabilities ?

Has any driver, had any Convictions ?:  in the last 5 years or ban in last 10 yrs

 Yes or No          If Yes, please give details below:
 

Name

conviction code
 Example (SP30)

conviction date

penalty points 

date ban expired

fine imposed
1

2

3

4

5

Has any driver had any Accidents?: in the last 5 yrs

 Yes or No        If Yes, please give details below:
 

Name

Date of accident

Fully
Settled Yet?

Total costs you claimed

Total costs  claimed against you

Fault or None Fault
1
2
3
4
5

How many years No Claims Bonus
can you provide.

 Was your bonus earned on
a landlord building/public property policy
or building car policy

ALL QUOTES PRODUCED ARE INDICATIVE ONLY


PLEASE KEEP A COPY OF THIS DOCUMENT SAFE FOR  REFERENCE