Residential Unoccupied Property Owners Proposal Form

Transcription

1 Residential Unoccupied Property Owners Proposal Form Disclosure The proposer must take care in answering all of the following questions which are relevant to the Insurer in providing this insurance and setting the terms and premium. Failure to provide information or the provision of incomplete or inaccurate information may result in the loss of cover or other remedies. The authorised individual completing this proposal form should make full and proper enquiry of all relevant parties within the proposer(s) named overleaf in relation to the answers given and all information and/or documentation supplied with or in relation to any question raised in this proposal form. The proposer must tell the Insurer as soon as possible about any changes to the information provided by them to the Insurer which happens before or during any period of insurance. The Insurer will tell the proposer if such change affects this insurance and if so, whether the change will result in revised terms and/or premium being applied to this insurance. If the proposer does not inform the Insurer about a change it may affect any claim the proposer makes or could result in this insurance being invalid. Presentation All questions must be answered. If there is insufficient space to provide answers, additional information should be provided separately. Failure to present the Insurer with information in an appropriate manner may adversely influence the ability of the Insurer to offer terms. Guidance If in doubt as to the meaning of any question contained within this proposal form or the issues raised in 1) Disclosure and/or 2) Presentation, advice should be sought from the proposer s insurance advisor in the first instance. The Insurer recommends that the proposer keeps a record, including copies of letters and this proposal form, of all information supplied to them for the purposes of providing this insurance. Data Protection Any information the proposer has provided will be dealt with by the Insurer in compliance with the provisions of the Data Protection Act For the purpose of providing this insurance and the handling of any claims or complaints which may arise under it, the Insurer may need to transfer certain information which the proposer has provided to other parties. By signing this proposal the proposer agrees that such transfer(s) may be made. Proposer Details Full Name or trading title: Date of Birth:.. Occupation:... Correspondence Address: Post Code:. Address of the Property to be Insured: Post Code:. Page 1 of 6

2 Property Details Type of Property:.... If there is a lift installed within the property, please confirm whether it is switched off or isolated? Yes No Are the following services switched off? Electricity: Yes No Gas: Yes No Water: Yes No If you have answered No, to any of the above, please provide full details of why they are not: Unoccupancy Details How long has the property been unoccupied?... What are the circumstances behind the unoccupancy? For how long do you anticipate the property will be unoccupied? What are your intentions for the property for the future? Are any surrounding properties also unoccupied? Yes No Have any emergency services attended the property whilst it has been unoccupied? Yes No If so, please provide details: Page 2 of 6

3 Construction & Maintenance What year was the property built?... Is the property built solely of brick, stone or concrete with timber or concrete floors and roofed with slates, tiles, asphalt, metal or concrete? Yes No What percentage of the roof structure is flat?... Is the property grade listed or situated within a conservation area? Yes No If Yes, please confirm grade?... Is the property in a good state of repair and will be maintained so throughout the period of insurance? Yes No Are there any outbuildings, excluding garages? Yes No If Yes, please provide full details:. How often are the premises inspected by you or your representatives?... Has the property had any occurrence of Subsidence, Landslip or Heave? Yes No Are you aware of any signs of damage which may be attributable to Subsidence, Landslip or Heave, such as step or diagonal cracking to walls? Yes No Is the property being, or has it ever been monitored for Subsidence, Landslip or Heave? Yes No Has any survey mentioned settlement or movement of the property? Yes No Has the property to the best of your knowledge ever been underpinned? Yes No Is your property within a recognised coal mining area? Yes No Are there any trees or shrubs within 7 metres of the property which are more than 3 metres tall (whether inside or outside the boundary of the property to be insured)? Yes No Is the property within 500 metres of a cliff, quarry or other excavation? Yes No Is the property within 500 metres of any river, lake, stream, sea or watercourse? Yes No Is the property in an environmental agency recognised flood area? Yes No Has the property previously flooded? Yes No Security Details Please confirm the details of existing physical security in respect of the following: Whether all external doors are fitted with five lever mortice deadlocks or multi-point locking systems? Yes No Whether any patio doors are fitted with a central locking device with key operated bolts to top and bottom? Yes No Whether all operating windows are fitted with window locks? Yes No Whether perimeter fencing is in place? Yes No Whether the property is fitted with roller shutters, grilles or bars? Yes No Is the property fully protected with an Intruder Alarm? Yes No If Yes, please confirm the type of signalling and whether it is under an annual maintenance contract with an NSI/SSAIB approved contractor?..... Any other additional information regarding security:... Page 3 of 6

4 Personal History Are you domiciled within the United Kingdom? Yes No Have you or any proposed beneficiary of this insurance: Ever been convicted of or is any prosecution pending for any offence of any kind? Yes No Ever been declared bankrupt? Yes No Ever been involved with a company that has gone into liquidation, receivership or administration? Yes No Ever had any CCJ s or held any arrangements with creditors that are outstanding? Yes No Ever had insurance declined by any insurer? Yes No Ever had insurance refused by any insurer? Yes No Ever had insurance cancelled by any insurer? Yes No Ever had any special terms imposed by any insurer? Yes No If you have answered Yes to any of the questions above, please provide full details: Insurance History Please state the name of the current insurer?... If there has been no previous insurance cover or if there is a gap in cover since expiry of your last policy, please provide full details? Have you or any proposed beneficiary of this insurance, suffered any loss or incurred any liability, whether insured or not, during the last five years? Yes No If Yes, please provide full details including the dates, type of claim, the circumstances and the value: Further Information Is the property to undergo any renovation, refurbishment or structural alteration? Yes No If Yes, please answer the following questions: Please provide full details of the works to be undertaken, including the value? Is planning permission necessary? Yes No Has planning permission been obtained? Yes No Are the works to be undertaken by a professional contractor? Yes No Does the professional contractor have the relevant insurances in place? Yes No What is the anticipated duration of the works?... Is any part of the property to be demolished? Yes No Page 4 of 6

5 Additional Information Please add any additional information relating to any answer provided on this form below: Page 5 of 6

6 Insurance Cover Required Please ensure that the sums insured provided by you are sufficient as the consequences of being underinsured can be significant. Level of Cover Please select the level of cover you require: Level 1 Fire, Lightning, Earthquake, Explosion, Aircraft only (FLEEA Perils) Level 2 Full Perils but limited to 2,500 for any claim in respect of Escape of Water, Theft or Attempted Theft and Malicious Damage Level 3 Full Perils Please Note: Accidental Damage cover is NOT available with any Level of Cover. Section One Buildings It is important that you ensure that the value of the property insured represents the total cost to rebuild your property (this is not the market value). This should represent the total cost to rebuild your property including architects, surveyors, consulting engineers, debris removals and legal fees you would be required to pay. Please advise the total cost to rebuild the property?... Section Two Contents (optional) It is important to ensure that value to be insured represents the full cost of replacing as new any household goods within the property that you either own or are legally liable for. Please advise the total cost to replace the contents at the property?... Section Three Property Owners Liability This is automatically provided with a 2,000,000 limit of indemnity any one loss. Please advise if you wish to increase this to 5,000,000? Yes No (Please note that an additional premium will be required for this increase) Policy Excesses A standard excess of 250 for all perils (where applicable) increasing to 1,000 for subsidence will apply. Please advise if you wish to increase your excesses by any of the following amounts in order to receive a discounted premium: 500 (7.5%) 1,000 (12.5%) 2,500 (17.5%) 5,000 (22.5%) 10,000 (25%) Declaration Please read the following declaration carefully and read again the questions and answers especially if not completed in your own hand, before signing the form. I/We declare that the information disclosed in this proposal, is to the best of my/our knowledge and belief both accurate and complete. I/We have taken care not to make any misrepresentation in the disclosure of this information and understand that all information provided is relevant to the acceptance and assessment of this insurance, the terms on which it is accepted and the premium charged. I/We agree that if any answers have been completed by any other person, such person shall for that purpose be regarded as my/our agent and acting on my/our behalf. Signature of Proposer(s).... Date:. Date:. Please Note: No cover is in force until this proposal is accepted by the Insurer and the premium is paid. The Insurer reserves the right to decline any insurance proposal or to offer different premium and terms from those quoted dependent of the information the proposer has provided. It is hereby agreed that the Insurer is authorised to make any investigation and inquiry in connection with this proposal that it deems necessary. The proposer and the Insurer are entitled to choose the law that will govern this contract of insurance. The Insurer proposes English law and this will apply unless otherwise agreed. Property UK, 10 Flag Business Exchange, Vicarage Farm Road, Peterborough, PE1 5SL Property UK is a trading style of Unicorn Underwriting Ltd. Authorised and regulated by the Financial Conduct Authority (FCA No ) Registered Office: 107 Leadenhall Street, London EC3A 4AF England No UNIRUNv16.1 (06/2016)