Proposal Form
Full name of Proposer (if not a Limited Company, show full names of all Principals/Partners and the Trading Name)
Your address
Post code
Email Address
Telephone No
Fax No
Date from which Insurance cover is required
 
Full address(es) of properties this insurance relates to, indicating property type (e.g. detached/semi-detached/terraced etc)
AddressPostcodeProperty Type
Occupancy
1. Is the property occupied by:-
Professional TenantsStudent TenantsRefugees/Asylum SeekersOther DSS Tenants
Yes No
    
Yes No
    
Yes No
    
Yes No
 Others (please specify)
2. Is the tenancy agreement between the Landlord & Tenant directly?
Yes No
3. Do you live on the premises?
Yes No
    If No, is there an appointed manager or caretaker living there?
Yes No
   
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Authorised and Regulated by the Financial Services Authority
Registered Office:
Lygon House, 50 London Road, Bromley, Kent. BR1 3RA