Giles - Apply

High Net Worth Home and Motor Insurance Application

Please complete the Enquiry Form below and one of our experienced Account Executives will contact you within one working day.

Personal details - please complete the following

Name of Proposer:

Full Address:

Post Code (first half only):

Tel. No.:

Fax No.:

E-mail:

Date of birth:

Your Occupation:

Date from which cover is required:

Risk information

Address of property to be insured:
If different from postal address

Year property was built:

Type of property:
i.e. Terraced, Flat, Bungalow etc.

No. of Bedrooms:

Do you have smoke/fire
detection alarms? (please select)

Is the property:

Rented Out?

Vacant?

Thatched?

Under renovation?

Theft protection

Do you have an unmonitored intruder detection system?

Do you have an alarm connected to a central station facility?

Alarm make

Is it NACOSS approved?

Is there an annual maintenance contract in force?

Please supply your main Contractors name?

General Questions

With regard to the sections you have selected, have you or any person normally residing with you at your present address or elsewhere:

- sustained any loss, damage or liability

If so please provide details

- had any insurer decline or cancel insurance

If so please provide details

Please indicate your selected deductible (excess).

This applies to the Buildings and Contents sections only.

Do you require Accidental Damage?

Sums insured

Type	Amount	Individual Items	Total
Buildings	£	£	£
General Contents	£	£	£
Jewellery	£	£	£
Jewellery (in a vault)	£	£	£
Fine arts	£	£	£
Furs	£	£	£
Stamps	£	£	£
Precious Metals	£	£	£
Guns	£	£	£
Other	£	£	£

Please list items to be specified. If any items to be insured under this section of the policy are not normally retained at the address of the property to be insured, please provide full details in this additional information area, of the item(s) and their normal place of safekeeping.

List all other items here with details