APPLICATION FORM FOR A HOUSEHOLD INSURANCE QUOTE NOTE: Please don't use the enter/return key on your keyboard until you complete the form; it results in the form being sent before it has been completed! - You can use the tab key to move to the next line. PROPOSER Mr:...Mrs:...Ms: Surname First name Date of birth -- dd/mm/yy E-mail Tel Fax Mobile Post address - Line 1 Post address - Line 2 Post address - Line 3 RISK ADDRESS - Line 1 Town Postcode Property type Owner or tenant? Owner..... Tenant Main residence? Yes......... No Holiday home? Yes......... No In what year was the property built? Is the property a chateau; a manor house? Yes......... No Is the property listed? Yes......... No BUILDING DEVELOPED SQUARE AREA ....Floor Area Calculate yoursurface area...! Cellar ........m² To use this Web page interactively, you must have Microsoft® Internet Explorer 4.01 or later and the Microsoft Office Web Components. See the Microsoft Office Web site for more information. Lower ground floor ........m² Ground floor ........m² First floor ........m² Second floor ........m² Third floor ........m² Attic ........m² TOTAL ........m² NUMBER OF ROOMS .... (Excluding kitchen if less than 30 m², bathroom, entrance hall, laundry, corridors... ) Does the property have a GLAZED CONSERVATORY? Yes......... No Is there a swimming pool? Yes......... No If Yes: Give the value of the swimming pool (as NEW) ........euros OUTBUILDINGS Nature of outbuildings Total developed surface area (all floors) ........m² CONTENTS VALUE General Contents ........euros Including valuables ........euros (Valuable objects are: Jewellery, silver, gold, objects of any value. Paintings, drawings, sculptures, books, collections, rugs, furs, weapons, bibelots and other decorative objects, clocks if their unit value exceeds 1,500 €, other objects of which the unit value exceeds 9,000 €. Usual furniture such as chairs, tables, chests of drawers, cabinets, beds... etc., if they are not 'art objects', Hi Fi equipment, computers, DO NOT HAVE TO BE CONSIDERED AS 'VALUABLES' even if their value exceeds the unit value amounts stated above. NOTE: If you want 'all risks' insurance cover for some of your valuable objects, please ask for a special quotation.
To use this Web page interactively, you must have Microsoft® Internet Explorer 4.01 or later and the Microsoft Office Web Components. See the Microsoft Office Web site for more information.
Usual furniture such as chairs, tables, chests of drawers, cabinets, beds... etc., if they are not 'art objects', Hi Fi equipment, computers, DO NOT HAVE TO BE CONSIDERED AS 'VALUABLES' even if their value exceeds the unit value amounts stated above.
