Three Counties Insurance, uk home and household insurance brokers, buildings contents

   THREE
   COUNTIES
   INSURANCE

Household insurance quotation form

To receive a quote for household insurance, please input all your relevant details in the fields below, then click the button entitled 'Send Details'.

Personal Details

Title:
Forenames:
Surname:
Address:
Post Code:
Home Phone Number:
Fax Number:
Work Phone Number:
Email Address:
Date of Birth:	(eg 01/01/70)
Occupation:

About Your Home

Accommodation:
Is the property unoccupied during the day?:
House Type:
Construction:
If other, please give details (eg - thatched roof)
Year Built:
Number of Bedrooms:
Numbers of years claim free: (proof may be required)
Neighbourhood Watch Scheme Member?:
5 lever Mortice Deadlocks on ALL exterior doors?:
Is the house alarmed?:
Is the Alarm NACOSS Approved?:
Does the house have Smoke Alarm?:

Buildings

Type of Cover:
Sum Insured:
Present Insurer:
Claims Last Three Years:
If Yes, please give details:

Contents

Type of Cover:
Sum Insured:
Present Insurer:
Claims Last Three Years:
If Yes, please give details:
Maximum Value of Any One Item:

All Risks

This cover is for items taken outside the home. eg, video cameras.

The following six items are optional extras.

Note: some policies will automatically include some of these options as standard.

Personal Effects (e.g. clothes):
Details and values of any individual items worth more than £500
Valuables:
Photographic Equipment:
Credit Cards:
Money:
Freezer Contents Value:
Legal Expenses Cover:
If you have already been given a quote, please enter the figure here:
Which insurer was this quote from?:
Please give the renewal date of your existing policy or the commencement date of the new policy:

Russell House, Ely Street, Stratford-Upon-Avon CV37 6LW
Phone: +44 (0)1789 293815 Fax: +44 (0)1789 299301
Freephone: 0800 731 7829
e-mail: info@3co.co.uk

site design by bf internet