Client Details

Property Postcode

Address Line 1

Address Line 2

Address Line 3

Post town

Postcode(Required)

Name(Required)

Phone Number(Required)

Email(Required)

Date of Birth(Required)

Buildings Sum insured

Do you wish to include accidental damage with your buildings cover

Contents Sum insured

Do you wish to include accidental damage with your contents cover

Renewal Date

Current Renewal Premium

Property Details

Type of Property(Required)

Number of Storeys(Required)

Number of Bedrooms(Required)

Owner Type(Required)

Build Date Range(Required)

Walls Build Material(Required)

Roof Build Material(Required)

Flat Roof(Required)

Listed building(Required)

Year started living at this property(Required)

Security Details

Property has a fitted burglar alarm(Required)

Property has a smoke alarm(Required)

Property has good quality locks on all main exit / entry doors(Required)

Property has key operated locks on all windows accessible from outside(Required)

Property is located in a policy approved neighbourhood watch area(Required)

Optional Extras

Total value of personal possessions away from the home (excluding valuables)

Total value of valuable items away from the home (items exceeding £1,500)

Cover for Money and Credit Cards

Cover for Freezer Food

Sports Equipment Cover

Pedal Cycles

Insurance History

How many years of continuous insurance without a claim?(Required)

Have you been declined building or property insurance or had a policy cancelled, withdrawn or offered on increased terms?(Required)

Have you been declared bankrupt or have not satisfied County Court judgement?(Required)

Has the property been free of flooding?(Required)

Has the property suffered from or been monitored for subsidence or be underpinned?(Required)

Data Protection Act

Some or all of the information which you supply to Sharrock Insurance Services Limited (Sharrocks), in conjunction with this quotation, will be held by us. We may use some of the information to advise you of other products and services. This information will not, however be passed to any other organisations without your permission other than is necessary to provide this insurance.

Please click here to view our full terms of business.

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