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Alexander Swan Insurance Services Ltd
0800 458 0082
info@alexanderswan.com
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Landlord Home Emergency Cover
Commercial Landlords
Personal
Home Insurance
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Construction
Fleets
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0800 458 0082
info@alexanderswan.com
Full Client Name
Address
Company name or limited liability partnership, charity, trust or association name:
Activities
Status of Entity:
Association
Club
Society
Sole Proprietor
Trust
Trustee
Partnership
Public Limited Company
Private Limited Company
Trade:
Property Owner
Property Developer
Property Letting
Previous Insurer:
Details:
Year Business Established:
Convictions:
Yes
No
Bankruptcy:
Yes
No
Insurance Cancelled:
Yes
No
Renewal Declined:
Yes
No
Special Terms Applied:
Yes
No
Previous Losses:
Yes
No
The business does comply (where applicable) with the requirements of the Regulatory Reform (Fire Safety) Order 2005 or the equivalent legislation in Scotland and Northern Ireland:
Yes
No
Is the insured exempt from holding a HM Revenue & Customs Employer`s PAYE Reference Number?
Yes
No
Effective Date
Date Format: MM slash DD slash YYYY
Term End Date
Date Format: MM slash DD slash YYYY
Listed building
Listed
Not Listed
Grade
1
2
Details:
Premises name
Premises address
Property type
House
Bungalow
Flats (Converted)
Flats Purpose Built
Number of flats
Year built (yyyy)
Date
Date Format: MM slash DD slash YYYY
The property is of non-standard construction [walls not built only of brick, stone or concrete or roofed only with slates, tiles or concrete]
Yes
No
The property has external cladding/external wall insulation
Yes
No
Building roof is flat or partially flat
Yes
No
You are aware of any previous flooding at the premises, whether or not it was insured and whether or not a claim was made
Yes
No
The property or adjacent property has suffered from, or shows any visible signs of damage from subsidence, landslip or ground heave
Yes
No
Risk Management
Additional security details
24 Hour Site Security
Yes
No
Guard Dog(s)
Yes
No
Other Monitored CCTV
Yes
No
Private CCTV
Yes
No
Proposer/family members or employees residing above
Yes
No
Security Patrols
Yes
No
Town Centre/Local Authority CCTV
Yes
No
Construction and Exposure
Number of storeys where floor is of concrete construction
Number of storeys where floor is of wooden construction
Heating
Fire - Open
Yes
No
Fire - Other
Yes
No
Fixed Heaters
Yes
No
Hot Air
Yes
No
Night Storage Heater
Yes
No
Oil Heater
Yes
No
Portable Heaters
Yes
No
Pressure Jet Heater
Yes
No
Radiant Panel Heater
Yes
No
Radiators - Hot Water
Yes
No
Radiators - Oil Filled
Yes
No
Stove
Yes
No
Underfloor
Yes
No
Wood Burner
Yes
No
Radiators (Hot Water) - Fuel type
Gas
Yes
No
Excess (£)
100
Covers Requested
Contingencies
Accidental Damage
Yes
No
All Risks
Yes
No
Escape Of Water
Yes
No
Flood
Yes
No
Sprinkler Leakage
Yes
No
Standard Fire & Specified Perils
Yes
No
Subsidence Ground Heave Landslip
Yes
No
Theft Or Attempted Theft
Yes
No
Other Contingencies
Yes
No
Buildings
Declared value (£)
Sum insured (£)
Method of adjustment
Contents
Sum Insured (£)
Sum insured (£)
Method of adjustment
Contents
Rent Receivable
Sum insured (£)
Indemnity period (months)
Occupancy Details
Occupant Type
Commercial
Yes
No
Residential
Yes
No
Residential Occupancy
Occupant Type
Working Occupant(s), Not Benefits Assisted
Number of occupants
Residential Occupant(s)
Construction and Exposure
Premises use
Rent funded by
Private Dwelling Only
Direct from Tenant
Additional Information
Limit of indemnity (£)
2000000
5000000
10000000
89071
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