John Ansell Residential Property Owners Scheme

Contact Details

Contact Name: *

Correspondence Address: *


Post Code: *

Telephone: *

Email: *

Business Details

Name of Proposer: *

Address of Property:

Post Code:

Only required if different to the Contact Address.

Premises Details

Are the premises Purpose Built?
Yes
No
If 'No' please state date of conversion:

Number of Flats:

Sum Insured

Buildings:

Contents of Communal Areas:

(Cover is automatically provided up to £ 25,000).

Claims

a) Have you had any claims during the last five years?
Yes
No
b) Have the premises ever suffered from subsidence, heave or landslip?
Yes
No
If 'Yes' to either (a) or (b) then please provide details below of the date, type of claim/damages, and amount claimed:

Details of Current Insurance

Name of existing Insurers:

Current Insurance Premium:

Renewal Date:

*Denotes mandatory field