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1 Your Details

2 Property Information

3 Previous Claims

4 Statement Of Values

5 Last Questions

3. Previous Claims
Have you or any person living with you sustained any loss or damage during the past five years (which would have been covered by this type of insurance had it been in force)?*
- Yes
- No
Please give details below ...
Date

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Details
Amount
Date

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Amount
Date

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Date

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Please give details of any additional claims
Has any insurer declined to accept, cancelled, refused to continue or agreed to continue only on special terms (Any insurance for the proposer or any other person to whom this insurance would apply)?*
- Yes
- No
If yes, please describe ...*

5. Last Questions
Have you or any other person residing with you been convicted of, or charged with but not tried for, any offence other than a driving offence?*
- Yes
- No
If Yes, give details ...*
What is your current renewal date?*

DD
MM
YYYY
Who is your current insurer?*
Where did you hear about Thatchline Insurance?
What is your current premium?
What is your target premium?
How would you like to be contacted for a quotation?*
- Telephone
- Email
- Post
- Fax
Do you have a promotional code?
Your Privacy*
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