Household Insurance, Sheffield, South Yorkshire

This insurance applies within the UK only!

Unique and competitive buildings and contents insurance with 3 extra lifestyle discounts for non-smokers, non-drinkers and church and charity affiliation.

Please use the form below to request a quotation for household insurance. Please complete as much of this form as possible to enable us to come back to you with a speedy response: note that the items marked with an asterisk * are required.

If your web browser does not support forms such as this, then please ask our email auto responder for a text version of this form.

Alternatively you could print this page and fax it to us on (01909) 550840 or send it via the Royal Mail to us at the address below.

Personal Details

Title Initials
Surname*
Male Female Organisation
Occupation
Date of birth
Date cover required*
Daytime telephone number
Email*

Special Terms

We offer special discounts if you are able to answer any of the following questions affirmatively:
Are you a non-drinker (never drink alcohol)? [Yes] [No]
Are you a non-smoker (for at least the last six months)? [Yes] [No]
Are you a church member or a charity worker? [Yes] [No]
If your answer to the last question was "Yes", please name the connection:

Home Details

Address of home to be insured*
Postcode

General Details

When was the home built?	Not known	Pre 1850
	1851-1919	1920-1979
	1980-1989	1990 to date

Is it used for business but restricted to clerical work? [Yes] [No]
If "Yes", do you require cover for your own office equipment while in the home up to £5,000? [Yes] [No]

Number of claim-free years?	None	One
	Two	Three
	Four or more

Security
NACOSS approved and maintained security alarm? [Yes] [No]
Other security alarm fitted? [Yes] [No]
Neighbourhood watch? [Yes ] [No]

Cover Details

Voluntary excess required for extra discounts?
[Nil ] [£50 ] [£100 ]
(this is in addition to the standard policy excess of £50)

Do you require cover for Buildings? [Yes] [No]
If "Yes", do you require accidental damage cover? [Yes] [No]
Sum insured required: £ (£35,000 minimum sum insured)

Do you require cover for Contents? [Yes] [No]
If "Yes", do you require accidental damage cover? [Yes] [No]
State the total contents sum insured: £ (excluding specific items covered under the All Risks section below)
How many bedrooms does your property have?
Have you held continuous household insurance for the last 12 months? [Yes] [No]
How many claims (of up to £500) have you made in the last three years?

Do you require All Risks cover? [Yes] [No] (available ONLY if contents are insured)
Unspecified Personal Possessions: any item of jewellery, watches, photographic equipment, wearing apparel and articles usually worn or carried about the person. Excluding: contact lenses, hearing aids, pedal cycles over £250.
Sum insured single item limit required for All Risks Cover:

Total Sum Insured	Single Item Limit
£0	£0
£1,000	£250
£2,000	£500
£3,000	£750
£4,000	£1000

Pedal cycles valued:
[up to £250 ] [£251-£500 ] [over £500 ]
Portable Computer £
Mobile Phone £

Additional Information

Please use this space to provide any additional details you think might be relevant, or to make any other comments.

All information provided will be treated in the strictest confidence and will not be made available to third parties.