Motts Godwin Insurance Services

All Classes of Insurance Transacted - Authorised and Regulated by the Financial Conduct Authority

Property Owners Quotation Form

Important Information

Our forms are designed to capture the information upon which a contract of insurance will be based. In order to provide a full quotation and/or issue cover we may require further information or the completion of a full proposal form.

All information you provide must be true and correct to the best of your knowledge and belief. Any information that is likely to influence insurers in the assessment or acceptance of an application should be disclosed prior to the inception of any policy. If you are in any doubt as to whether a fact is relevant you must disclose it.

It may not be possible to quote in all circumstances.

Personal information

Whilst not required for an initial quick enquiry, these fields may help speed our response.

  • Type of Insured?
Risk Property Details
  • If the property if of mixed occupancy please supply details in the ‘extra’ field below.

  • Are you insuring the whole property?
About the Property
  • Has the property been extended within the last 25 years?
  • Non-Standard Construction?

    Standard Construction will be deemed to be brick walls and a tiled or flat (under 33%) roof.
    If the property includes any area of flat roof, please advise the approximate percentage in addition to the construction material.
    Any additional information can be supplied in the space below.

Security
  • Final exit doors comply?
  • All other external doors comply?
  • Accessible windows/fanlights/skylights comply?
  • Please provide details of any additional security measures which may be in place. eg. CCTV, barred windows.

    Security requirements may apply with some insurers. Details will be provided upon quoting.

  • Is the home fitted with a burglar alarm?
    • Is the alarm maintained under a contract?
  • Does the property have a safe?
Declaration Statements about the property Is the property...
  • showing signs of, or does it have a history of subsidence?
    • Free from cracking?
    • Being monitored?
    • Survey mentions subsidence?
    • Subsidence in neighbouring buildings?
  • within 10m of any trees or shrubs?
    If yes, please provide details.
  • at risk of, or does it have a history of flooding?
    • Free from flooding and coastal or river erosion?
    • Over 200 metres from any river, stream, tidal waters or flood plains?
    • Ever suffered from flooding?
  • scheduled for any building works?
  • used for any business, trade or profession?
  • in a good state of repair?
  • ever unoccupied for over 30 days?
  • regularly unattended?
Cover and Sums Insured
  • Would you like cover for Accidental Damage on Buildings?
  • Would you like cover for Accidental Damage on Contents?

For Owner Occupied Properties requiring Contents please contact us by telephone to obtain a full quotation.

Claims (Non Motor)
  • Any claims or losses in the last 5 years?
  • Date Details include circumstances and any post loss action to prevent reoccurrence Amount(s) Paid Cause Status
Declaration Statements
  • Any convictions or charges pending?
  • Ever bankrupt or entered into bad debt arrangements?
  • Insurance cancelled, refused, declined or voided?
Third Party Financial Interest
  • Does any Third Party have a financial interest in your property?

    Please state any Building Society, Bank or other financial institution that is providing you with a mortgage or loan on your property.

Insurance information
Extra

Please use this space for any additional claims or information for which there was not room elsewhere.

Please remember that you must inform insurers of any circumstances of which they may not be aware. Failure to do so could invalidate a policy. If you are in any doubt as to whether a fact is material it should be disclosed.

* Required Field

Forms may make various assumptions in terms of the default answers to questions. Please ensure that you have checked all fields before submitting your information for quotation.
When you complete this form you are declaring that the information given is true and complete and that no relevant information has been withheld or omitted. You are also declaring that you understand the contents of this completed application including the important information at the start of the form.
You should keep a record of all information supplied to us for the purpose of this application

You should keep a record (including copies of letters) of all information supplied to us for the purposes of this insurance.

Call 0208 444 1040