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TopQuotes Buildings and Contents Quotation
Complete this one form and TopQuotes will search the market for the best home insurance quote for you. Compulsory fields are marked with a red star.
	Proposer Details
	Title
	First name
	Surname
	Age of Client
	Occupation
	Period of insurance (e.g. 12 months)
	Address of property to be insured - line 1
	Address of property to be insured - line 2
	Address of property to be insured - line 3 (City / Province)
	Address of property to be insured - line 4 (Postcode)
	Is contact address same as property address?	Yes No
	Contact address - line 1
	Contact address - line 2
	Contact address - line 3 (City / Province)
	Contact address - line 4 (Postcode)
	Phone
	Email
	Please re-enter email
	How would you like us to contact you?
	How many bedrooms does the property have?
	Is the property your main residence?
	How long is the property left unoccupied during a typical year?
	Have you made a claim under a buildings and / or contents policy at any time in the last 5 years?	Yes No
	If the answer to the above is yes, provide the details including the amount (EUR) claimed
	Have you ever been refused home cover insurance?	Yes No
	If the answer to the above is yes, provide the details
	Does the property have a burglar alarm?	Yes No
	Buildings only
	Sum insured (EUR). This should be based on the cost of rebuilding not the market value. You should include the cost of replacing permanent fixtures and fittings.
	Contents only
	Sum insured (EUR). This should be based on the cost of replacing as new all removable contents.
	Of the above amount, how much of this are valuables (Jewelery, watches, works of art, etc)
	All risks for selected valuables (away from home)
	Sum insured (EUR). This should be based on the cost of replacing as new all valuables.
	Please describe any individual items valued at over 1,000 EUR
	Do you currently have home cover insurance?	Yes No
	Date of next renewal.
	Name of current insurer.
	What other insurance companies do you have policies with?
	Where did you hear about us?