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Proposal Form - High Value Homes

Please enter the required details and click submit to save.
All boxes marked * are required.

Insured
Date of Birth
Occupation
Premised Insured
Who is the existing Insurer?
What is the existing premium?
Renewal date
Valuations
Amount Date
Fine Art
Valuables
Buildings
Does the property have 5LMD's and KOWL?
YES NO
Is the property protected by an alarm?
YES NO
Is there a safe at the property?
YES NO
Listed?
YES NO
Are the premises of standard construction and free from flood, subsidence, landslip or heave?
YES NO
Is the main residence occupied daily?
YES NO
Is the main residence used for business purposes?
YES NO
Is the property likely to be refurbished within the next 3 years?
YES NO
Is the Insured in good health and not received any medical treatment within the last 12 months?
YES NO
Have there been any claims within the last 6 years including travel?
YES NO
Have any terms been applied by the existing insurer?
YES NO
If you have ticked any of the grey boxes please give details
BUILDINGS
Main Building
Outbuildings
CONTENTS
General Contents
(Including personal possessions but excluding jewellery)
Outdoor Items (2,500 free)
Pictures, paintings, sketches, prints
Books
Guns
Statutes, sculptures - non fragile
Antique furniture
Items of a brittle or fragile nature
Clock and other mechanisms
Gold, silver and other precious metals
Jewellery and watches - specified VALUABLES
(Provide details of all items over 5,000)
Jewellery and watches - unspecified
Jewellery in bank
Fur
Email Address *
This email address will be used for correspondence regarding this on-line form and for no other purpose.
I have read and agree to Brennan Insurances Terms and conditions.
YES NO
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