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Quotation Request

Residential Let

Disclosure
Insured Details
Premises Details
Cover Details
Security
Claims
Rates
Information
Flood Re

Disclosure

Underwriter
Your Responsibilities:

You are responsible for answering any questions in relation to any proposal for insurance cover honestly and to the best of your knowledge, providing complete and accurate information which insurers will require. This also applies to your responses in relation to any assumptions you may agree to in the process of applying for insurance cover. This is particularly important before taking out a policy but also at renewal or if you make a mid-term amendment to your policy. If you fail to disclose information, or misrepresent any fact which may influence the insurer’s decision to accept the risk or the terms offered, this could invalidate the policy and mean that claims may not be paid. You must check all details on any proposal form or Statement of Facts and pay particular attention to any declaration you may be asked to sign.

It is important that you read all insurance documents issued to you and ensure that you are aware of the cover, limits and other terms that apply. Particular attention must be paid to any conditions as failure to comply with them could invalidate your policy.

You must inform us immediately of any changes in circumstances which may affect the services provided by us or the cover provided by your policy.

If you are unsure about any matter, please contact us for guidance.

Does the policyholder currently hold insurance?
Please provide date of last insurance held:
Please advise of the reason for no insurance:
Have you or any persons living with you ever been convicted of, or have a prosecution pending for any offence, other than a driving offence?

You do not have to declare any offence deemed to be SPENT under the Rehabilitation of Offenders Act 1974 amended by the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LAPSO).

Please provide full details:
Has any person to be covered by this insurance ever had an insurance contract cancelled, refused or declined by an insurer?
Please provide full details:
Has any person to be covered by this insurance ever had an insurance contract declared void by an insurer?
Please provide full details:
Has any person to be covered by this insurance ever had different terms applied to an insurance contract by an insurer due to misrepresentation by:

  • providing misleading or incorrect information

  • deliberately or recklessly withholding information

  • providing false documents

    • Please provide full details:
    Has any person to be covered by this insurance been declared bankrupt or insolvent either as private individuals or in connection with any business within the last ten years?
    Please provide full details:
    Has any person to be covered by this insurance been the subject of a County Court Judgement (or the Scottish equivalents) in respect of debt as private individuals or in connection with any business within the last six years?
    Please provide full details:

    Insured Details

    When would you like the policy to start?
    Should cover be required, this would form the start date of the policy (This cannot be more than 45 days from today)
    Is the Proposer a company?
    Company Name
    Client Name
    PolicyContactName
    Date of Birth
    Do you reside in the UK?
    What is your country of residence?
    Correspondence Address
    Is your occupation any of the below?
    Antique Dealer | Professional Gambler | Professional Sportsperson | Firearms Dealer | Door Supervisor | Nightclub Owner | Oil Rig Worker | Furrier | Market Trader | Entertainer | Television Personality | Model | Journalist | Racing Drivers | Actor | Comedian
    Occupation
    Contact Number
    Mobile Number
    Email Address
    These details will be used to access your account area and all Policy Documentation will be sent to the Email Address you provide.
    Would you prefer your documentation & correspondence to be issued by email or post?
    Is there a Third Party Interest to be noted?
    Third Party Interest
    Is there a joint insured?
    Joint Insured Details
    Title
    First Name/s
    Surname
    Date of Birth
    Is the joint insured's occupation any of the below?
    Antique Dealer | Professional Gambler | Professional Sportsperson | Firearms Dealer | Door Supervisor | Nightclub Owner | Oil Rig Worker | Furrier | Market Trader | Entertainer | Television Personality | Model | Journalist | Racing Drivers | Actor | Comedian
    Occupation

    Premises Details

    What is the address of the property to be insured?
    Type of Tenant:
    Reason for Unoccupancy:
    How long has the property been unoccupied for?
    Are there any works to be undertaken before the property is occupied?
    Please indicate the value of the works to be undertaken:
    £
    Is any part of the building boarded up?
    Is there an eviction notice in place?
    How many years have you owned the property?
    Please provide full details:
    Approximately what year was the property built?
    What is the type of the property to be insured?
    What storey of the property is the flat situated?
    How many storeys does the property have, excluding any basement?
    Does the property have a basement?
    Please advise how the property is heated?
    What is the litre capacity of the tank?
    Is the tank Double Skinned (bunded)?
    Is the tank within 5m of any source of water, drains or gulleys?
    Is the tank less than 35 years old?
    Was the heating system (including tank) installed by an Oftec Approved Technician?
    Is the system on an annual maintenance agreement with an Oftec Approved Technician?
    Is the client willing to put in place a maintenance agreement with an Ofec Registered Technician?
    What is the wall construction of the property?
    Standard Construction is defined as walls built from brick/stone/concrete and roofed with slate/tile
    Please provide full details:
    What is the roof construction of the property?
    Standard Construction is defined as walls built from brick/stone/concrete and roofed with slate/tile
    Please provide full details:
    Is the property maintained and in a good state of repair?
    Please provide full details:
    Are there any building works in progress or planned in the next 12 months?
    Nature and type of building work to be undertaken?
    Approximate value (£) of the Building/ Contract works?
    £
    Will the works be carried out in accordance with Local Authority requirements and regulatory conditions?
    Please provide full details:
    When will the building work commence?
    Expected duration of the work/ building contract? (weeks)
    Is there a Joint Contracts Tribunal (JCT), or other formal building contract, in place for the duration of the work?
    Please provide full details:
    Are bone fide/ competent builders or contractors undertaking the works?
    Please provide full details:
    What is the limit of the contractors Public Liability coverage?
    £
    Planned usage for the property once works are complete, i.e. owner occupied/ main home, to be let out or sold?
    Has the property suffered from subsidence (downward movement of the site on which the buildings stand by a cause other than the weight of the buildings themselves)?
    Please provide full details:
    Has the property suffered from landslip (sudden downward movement of sloping ground)?
    Please provide full details, (including claims costs and if any surveys have been carried out):
    Has the property suffered from heave (upward and/or lateral movement of the site on which the buildings stand caused by swelling of the ground)?
    Please provide full details, (including claims costs and if any surveys have been carried out):
    Is the property showing any signs of cracking that may be due to subsidence, landslip or heave (such as internal and/or external cracks, movement or distortion)?
    Please provide full details (including claims costs and if any surveys have been carried out):
    Are you aware of any survey carried out on the insured property which mentions subsidence, settlement, cracking or movement to the building?
    Please provide full details:
    Are you aware of any neighbouring property that has been subject to an occurrence of subsidence, settlement, cracking or movement?
    Please provide full details:
    Are there any trees or shrubs within 7 metres of the property that are over 3 metres high?
    Please provide full details:
    To the best of your knowledge is there a willow tree within 40m of the property?
    Please provide full details:
    Has the property ever flooded?
    Please provide full details:
    To the best of your knowledge, is the property in an area which has a history of flooding?
    Please provide full details:
    Is the property within 400 metres of a watercourse?
    Please provide full details:
    What Council Tax Band is the property in?

    Please be aware that if this information is incorrect your policy will be invalidated.

    You can check here:- For properties in England and Wales

    You can check here:- For properties in Scotland

    England and Scotland: A - H

    Wales: A - I

    Northern Ireland: 1 - 8

    Will the property be unoccupied for MORE than 30 consecutive days or for a total of 180 days or more in a calender year?
    Please provide full details:

    Cover Details

    Buildings Sum Insured

    This is the full rebuilding cost of the property, including the home and its decorations, fixtures and fittings attached to the home, permanently installed swimming pools, tennis courts, drives, patios and terraces, walls, gates and fences and fixed fuel tanks you own or for which you are legally responsible within the premises and named in the schedule.

    This also needs to be adequate to include architects', surveyors', consulting engineers' and legal fees, the cost of removing debris and making safe the building and costs you have to pay in order to comply with any Government or local authority requirements.

    £
    Is Accidental Damage for Buildings to be included?
    Are there any outbuildings to be included within the buildings sum insured, that are not used for private or personal use?
    Please provide full details:
    Loss of Rent
    12 month Indemnity Period
    £
    Landlords Contents Sum Insured

    Household goods and furnishings, within the home, which are your property and form part of your tenancy agreement.

    Contents includes: The household goods of the buildings including: furniture, furnishings, photographic equipment, money, outdoor items, business property, gardening implements, tractors and their trailers used solely for domestic purposes, fine art and antiques, your fixtures and fittings including interior decorations if you are not responsible for insuring the buildings all of which belong to you or for which you have a legal responsibility.

    Contents does NOT include: caravans, aircraft, watercraft or mechanically propelled vehicles, other than: • domestic gardening equipment, • electric wheelchairs, • models and toys and their spare parts and accessories, (although cover is provided for your computerised motor vehicle accessories when taken out of the vehicle and kept in the building of your home) any part of the structure of the buildings, animals, personal possessions or credit cards.

    £
    Is Accidental Damage for Contents to be included?
    Public Liability
    £
    Is Employers Liability cover required at £5,000,000?
    Employers Liability
    £
    Set Strategy Load @ % £0.00
    Set + Auto Load £ £0.00
    Set Claims Load @ % £0.00
    Set Ireland Load @ % £0.00
    Set Conviction Load @ % £0.00
    Set Discretionary Load @ % £0.00
    Set Listing Load @ % £0.00
    Set Discretionary Disc @ % £0.00
    Set FloodRe Discount @ % £0.00
     
    Flood Re Buildings
    £
    Flood Re Contents
    £
     
    ARAG Legal
    £
     

    Security

    Have all of the doors and windows been fitted with the following:
    External doors secured by a mortice deadlock or a deadlock conforming to British Standard 3621 or by a multi-point locking system with either a lever or built-in deadlocking cylinder or key-operated security bolts fitted internally to the top and bottom?
    All accessible windows, fanlights and skylights fitted with key operated window locks?
    All outbuildings fitted with BS3621 locks and / or close shackle padlocks?
    Is there an alarm installed on the property?
    Has the alarm been professionally installed?
    Is there an annual maintenance agreement in place with an approved installer?
    Is there any other security features at the property?
    Please provide full details:
    Is there a safe on the property?
    Please provide full details: Make, Model, Cash Rating etc.

    Claims

    Have you or any persons living with you, ever sustained any loss, damage, injury or liability in the last five years, whether insured or not?
    Please provide details:
    Date Details PaidReserveMeasures Taken
    Add row
    Action taken to prevent similar loss(es) occurring again:

    Additional Information

    Do you want to bring any further information to the underwriters attention?
    Please provide full details:
    Where did you hear about us?
    If you have a discount code, please enter it here:
    Hiscox Referral Reason:
    Policy Reference of Referral
    Would you like us to contact you to discuss any of your other insurance needs?
    Life | Travel | Commercial | Household
    Please provide details of the insurances you would like to discuss, including renewal dates if applicable:
    How much do you currently pay for your insurance?
    £
    Stay in touch...

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    You'll receive newsletters full of interesting news and money saving ideas and other information about our other products and services that we think you'll be interested in. We may keep in touch via email, SMS, phone, post and other electronic means such as via social and digital media.

    Would you like to receive these updates from us?

    Rates

    Area Rate
    Accidental Damage Rate
    Age of Property
    Wall Construction
    Roof Construction
    NCD Rate
    Previous Subsidence
    Sum Insured
    Answer 1
    Answer 2
    Answer 3
    Answer 4
    Answer 5
    Answer 6
    Answer 7
    Contents Rate
    NCD Contents Rate
    Index Linking - Buildings
    Index Linking - Contents

    Information

    Postcode Used For Lookup
    Risk Postcode
    Area Code From Lookup (Hiscox)
    Contents Code From Lookup (Hiscox)
    Flood Check From Lookup (Hiscox)
    Flood Area (Hiscox)
    Area Code From Lookup (HCC)
    Contents Code From Lookup (HCC)
    Flood Code From Lookup (HCC)
    Theft Code From Lookup (HCC)
    Subs Code From Lookup (HCC)
    Security Code From Lookup (HCC)
    Message From Lookup (HCC)

    Please complete the below:

    Endorsements
    3 Digit Endorsement Code. Separate each endorsement with the | delimiter
    Castle Quote Reference
    Excluded Cover
    Reason for Non-Standard
    House Number
    House Name
    Standard Excess
    £
    Escape of Water Excess
    £
    Flood Excess
    £
    Subsidence Excess
    £
    Is Subsidence included?
    RiskAlliance Rewards (NO LONGER AVAILABLE)
    Hiscox Reference
    Hiscox Policy Reference
    Cancellation Reason
    Where did this Hiscox lead come from?
    Reason Not Taken Up (for Hiscox)

    Flood Re

    Property Type
    Wall Construction
    Roof Construction
    Buildings Coverage Type
    Contents Coverage Type

    Please complete the following if Flood Re is included:

    Flood Re ID
    Flood Re Annual Premium Buildings
    £
    Flood Re Annual Premium Contents
    £