Personal Details   Firstname: Surname: Date of Birth: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Post Code:     Quotation Details     Approximate year built: Type of property: Please Select Detached House Detached Bungalow Semi-Detached House Semi-Detached Bungalow Terraced Property Purpose Built Flat Converted Flat Purpose Built Masonette Converted Masonette Number of Bedrooms: Please Select 1 2 3 4 5 6 7 8 9 10 Wall Construction: Please Select Brick Brick/Timber Frame Concrete Stone Ownership: Please Select Owner occupier. Tennant BTL     Buildings Insurance Yes No     Voluntary Excess: Please Select £50 £100 £150 £200 £250 £300 £350 £400 £450 £500 Accidental Damage: Yes No No Claims Discounts: Please Select 0 1 2 3+     Contents Insurance     Voluntary Excess: Please Select £50 £100 £150 £200 £250 £300 £350 £400 £450 £500 Accidental Damage: Yes No No Claims Discounts: Please Select 0 1 2 3+ Amount of Protection: Please Select £20,000 £30,000 £40,000 £50,000 £60,000 £70,000 First Time Buyer     General Details     Smoke Alarm: Yes No Daily Occupancy: Please Select Regularly Occupied During the Day Regularly Occupied During the Night Regularly Occupied During the Day & Night. Number of years Buildings Insurance: Please Select 0 1 2 3+ Number of years Contents Insurance: Please Select 0 1 2 3+ Approved Alarm: Yes No Neighbourhood Watch Area: Yes No Key Operated Window & Door Locks: Yes No Door Locks to Minimum Standards: Yes No     Contact Details     Home Tel: Work Tel: Mobile: Email: