SR Insurances - Home Insurance Quotation

Home Insurance Quotation

By simply filling in this form you will soon receive a very competitive insurance quote from SR Insurances. We will deal with your enquiry promptly and return a quote to you as quickly as possible.

Type of insurance required
Both buildings and contents insurance
Buildings insurance only
Contents insurance only

About You…
Title

Forenames

Surname

Date of Birth (eg 27/04/1963)

Marital Status

Sex

Address

Postcode (this is essential to enable us to provide a quotation)

Home Telephone Number

Work Telephone Number

E-mail address

Fax Number

About your work…
Employment Type

Occupation

Type of Business

Have you ever been declined insurance?

If you would like the insurance to be in joint names, please fill in your partners details.

About Your Partner…
Title

Forenames

Surname

Date of Birth (dd/mm/yyyy)

Marital Status

Sex

Employment Type

Occupation

Type of Business

Have you ever been declined insurance?

Your Current Insurer…
Who is your current insurer?

How many years with this company?

When does your current policy expire? (dd/mm/yyyy)

Have you made any claims under a previous home insurance policy within the last 5 years?

If 'No', how many years of claim free insurance have you had?

If 'Yes', please give details of the types of claim and the relevant dates

About your home…
What sort of property do you have?

When was the property built?

What is the property made of?

How many bedrooms?

How many lodgers live in your home?

Has the property ever suffered from subsidence, slippage, heave, settlement or flooding?

Is the property used for any business use?

If 'Yes', please enter details

Do you own the property?

Do you occupy this property?

Do you let this property?

If 'Yes', what type of occupier?

Is the property used as a holiday or weekend home?

Does anybody living in your home smoke?

Does anybody living in the property have a criminal convictions?

Buildings Details…
What is the total sum insured on the Buildings of your home?

Would you like Accidental Damage included?

Contents Details…
What is the total sum insured on the Contents of your home?

Would you like Accidental Cover included?

Would you like to cover personal belongings away from home?

If 'Yes', what sum insured is required?

Is any item worth in excess of £1000?

If 'Yes', please give details of the item(s)

If you would like cover for the following items, please insert to what value.

Money

Credit Cards

Pedal Cycles

Security
Are you a member of a Neighbourhood Watch scheme?

Does your home have a professionally installed burglar alarm?

Is the alarm company a member of NACOSS?

Do you have 5 lever mortice door locks?

Do you have key operated window locks on all ground and first floor accessible windows?

Is your home left unoccupied during the day?

Is your home ever left unoccupied for more than 30 consecutive days?

Is your home ever left unoccupied for more than 60 consecutive days?

And finally…
Is there anything else you need to tell us about?

How did you hear about this web site

The personal details you have submitted on this form will be used only for the purposes of supplying you with a quotation. None of this information will be made available to other companies or organisations for the purpose of mailing, promotions, direct selling or any other offers.

Thank you for filling in this form. Please ensure you have filled in as much as possible - the more details you give us the better quote we can give you!

For you own records you may like to have a printed copy of this form. Just press the Print Form button.
Press the SEND button to forward your details to us.

Countrywide member - trust us to put you first We will forward a quote as soon as possible.

Back to Household Insurance

Sharpley & Regent Insurance Services Ltd.
38 Alexandra Road, LOWESTOFT, NR32 1PW
Tel: 0845 130 0202 (Calls charged at local rate)
Fax: 01502 532605

ã Sharpley & Regent Insurance Services Ltd. 1999 - 2007