Quotation Request

Occupied Household (including non-standard)

Proposer Details

The Property

Cover Required

Cover Away From the Home

Additional Cover

Declaration

Rating Questions

Notes

Documents Only

Excesses

Proposer Details

Untick once complete

Subjectivities

Subjectivities for this case

INTRODUCTORY STATEMENT:

Please confirm that you will answer all these questions accurately, to the best of your knowledge and most importantly, honestly.

When would you like the policy to start?

The Executors of the estate of :

The Administrators of the estate of :

Company name :

Trustees of :

Name

Full Name

Date of Birth

Please select the option that best describes your occupation

What industry do you work in?

Please specify your occupation:

Trade Code

Referred Occupancy

Please give details of any other persons to be named on this policy

Title	Forename	Surname	Date of Birth

Interested Parties

Please provide details of one or more interested parties below

Click on the + or - to add or remove an Interested Party

Name	Address Line 1	Address Line 2	Town	County	Post Code	Ref

PostcodeNoSpace

AmTrust Flood (1 = Flood risk)

PostcodeIPTCheck

PostcodeRatingBand

PostcodeRatingArea

Affinity - Buildings Area

Affinity - Contents Area

Affinity - VPP

Affinity - Cycle

Affinity - Notional Area

Affinity - TheftBand (10 = High)

Affinity - Subs Band (6 = High, 10 = Extreme)

Affinity - Area Grade (6 = High)

Affinity - Flood Band (6 = High, 10 = Extreme)

PPD Subs (4 = High, 5 = Extreme)

PPD Flood (4 = High, 5 = Extreme)

PPD Crime (1 = Negligible, 5 = Extreme)

PPD Terror (1 = Negligable, 4 = High)

PPD Arson (1 = Negligible, 5 = Extreme)

Property Details

Address of Property to be Insured

            UDPRN
        
            UPRN
        
            Organisation
        
            Line 1
        
            Line 2
        
            Town/City
        
            County

Postcode

Please be advised we are not currently writing Household risks in Northern Ireland.

Is the correspondence address the same as the address of the property to be insured?

YesNo

Correspondence Address:

            UDPRN
        
            UPRN
        
            Organisation
        
            Line 1
        
            Line 2
        
            Town/City
        
            County

Postcode

How many years have you continuously held home insurance?

Number of Garages in Total

Number of Long Term Leasehold Garages

Year of original construction:

Is the building listed ?

Please provide details:

Please provide details

Building Construction

Please provide details of the construction of the walls:

Please provide details of the construction of the roof:

Please provide details of the construction of the flat roof:

Please provide additional info about the property’s state of repair.

Subsidence Questionnaire

Please provide details:

Please provide further details:

Please provide details of all trees within 7 meters including species, height, distance from property and ownership:

Please provide details:

Building Works or Refurbishment

Please provide full details of the works to be undertaken:

Please provide full details of the works being undertaken

Value of Works

What is the anticipated duration of the works (weeks)?

Start date for works

Unoccupied Through Works Minimum Premium

JCTPremium

JCT Minimum Premium

Security Information

Please provide additional information in respect of the above

Is there an intruder alarm
fitted (and used)?

Please provide details of the alarm installed:

Please provide the make, model and cash rating of any safe installed on the premises:

Buildings Cover

What is the rebuild value?

. Buildings Sum Insured Rated

. Building Sum Insured Included

Buildings Notional Value

Rating Method

Notional or SI Basis (0 = Notional / 1 = SI) - use dropdown above this question to overwrite the rating method

0 = Notional
1 = Sum Insured

Reason to change rating method

Please explain the reason you've changed the rating method

No longer used - Requested Buildings

Added 16.01.17.
This field has been added for the SAGIC rating. It stores the Requested buildings figure as previously the OIM Rating would uplift buildings to £600k.
DB Thinks this is no longer needed from 14/12/22 as Affinity are the only insurer. Ticket 5199

Contents Cover

Items permanently within the home only

This policy automatically includes:

Contents cover of £80,000 of which 30% may be high risk items including computers, televisions, video and audio equipment, photographic equipment, jewellery, articles of precious metal, precious stones, watches, clocks, furs, pictures, works of art, curios, telescopes, microscopes, musical instruments and sets or collectibles/ collections including, but not limited to stamp, medal and coin collections.
The maximum value of any one item is £2,500 unless specified below.

Contents Notional Value

Contents:

Please provide the total sum insured for all contents within the premises.

. General Contents Rated

. General Contents Included

Specified Items - Please specify any high risk items worth £2,500 or more:

High risk items are:
Items of gold, silver or other precious metals, jewellery, watches and furs, antiques, works of art, photographic equipment, musical instruments, spectacles, coins, medals and stamps and other collections, luggage, clothing, sports and camping equipment, mobile phones, portable computer equipment.

ALL contact or corneal lenses and hearing aids are high risk items, regardless of value and should be specified (unless they have been specified under the Personal Possessions section)

Item Description	Value / Sum Insured £

Property in the open cover:

Cover is automatically provided up to £1,000.
If you require more than £1,000 please enter the required sum.

Property In The Open Included

Property In The Open Rated

Theft of contents in outbuildings:

Cover is automatically provided up to £2,500.
If you require more than £2,500 please enter the required sum.

Contents In Out Buildings Included

Contents In Out Buildings Rated

Domestic Freezer Cover:

Cover is automatically provided up to £1,000.
If you require more than £1,000 please enter the required sum.

.Deep Freeze Included

.Deep Freeze Rated

Items stored permanently at a bank

Storage Contents Value

Please provide full address

            UDPRN
        
            UPRN
        
            Organisation
        
            Line 1
        
            Line 2
        
            Town/City
        
            County

Postcode

Please provide additional security details of storage location

Personal Possessions - Items in and away from the home

Please provide the TOTAL VALUE of ALL personal possessions to be covered away from
the home including jewellery and watches, guns, electronics, computers, phones and
other electronic devices INCLUDING ITEMS SPECIFIED BELOW.

Personal Possessions Rated

Specified Jewellery:

All Items with an individual value of £2,500 or more

Item Description	Value / Sum Insured £

Specified Computers and other Electronic Devices:

All items with an individual value of £2,500 or more

Item	Sum Insured £

Specified Mobile Phones:

All mobile phones with an individual value of £500 or more must be specified including make and model

Make / Model	Value / Sum Insured £

Specified Contact or Corneal Lenses or Hearing Aids:

All contact or corneal lenses or hearing aids with an individual value of £500 or more

Item	Value / Sum Insured £

Guns:

All guns must be specified regardless of value:

Gun Description	Value / Sum Insured £

Specified Other Personal Possessions not listed above:

All items with an individual value of £2,500 or more

Item Description	Value / Sum Insured £

Jewellery / Watches

Please provide the total value of all jewellery and watches including those specified below.

Computers, Phones and other Electronic Devices

Please provide the total value of all Computers, Phones and other Electronic Devices
including those specified below.

Money / Credit Cards

Money / Credit Cards (Free limit £500):

.Personal Money Included

.Personal Money Rated

Pedal Cycles

Pedal Cycles anywhere within the UK:

Standard Cover includes £500 per cycle. If any cycles are to be insured for more than £500 please specify them below.

Make / Model	Type of Cycle	Value / Sum Insured £

Do you require cover for Legal Expenses?

Legal Expenses

Our Household Package automatically includes a Family Legal Expenses policy covering the following:

Employment

Contract

Property

Personal Injury

Clinical negligence

Tax

Legal defence

Loss of earnings

Identity theft

Education appeals

Legal and tax advice helpline

Consumer legal services

Please Click here to see the Family Legals Summary of Cover.

Legal Expenses Fee

Home Emergency

Home Emergency Fee

Our Household Package automatically includes Home Emergency.

Please Click here to see the Home Emergency IPID.

Declaration

Have all residents living in the property been granted permission by the Executors/Administrators?

YesNo

Please provide details:

The insured property is occupied solely by you and immediate family as your main residence ?

YesNo

Please provide details:

Have you or anyone living at the proprety had any prior or pending criminal convictions (other than motoring)?

There is no need to declare spent convictions

YesNo

Please provide details:

Type of Conviction

Conviction Type	Date of Conviction	Conviction Description

Have you or anyone living at the property had a County Court Judgement, Sheriff Court Decree or been the subject of any bankruptcy or winding up proceedings?

YesNo

Please provide details:

Have you or anyone living at the property ever had insurance refused, declined, cancelled or had special terms imposed?

YesNo

Please provide details:

Claims Details

In the past 5 years, have you or anyone living at the property made any home insurance claims or suffered any losses or damage, whether insured or not?

YesNo

Please provide details of all claims below

Type	Date of Loss	Amount of Loss	Claim Status	Claim Details

Is there anything else you are aware of which could result in an increased risk of damage to the property?

YesNo

Please provide details

Business Activities

What is the nature of your business:

Business Use

Please provide details:

How many business callers visit the premises per month

Business Equipment

Computers, home office equipment and other equipment belonging to you and used in conjunction with your business at the home. Please ensure that your contents sum insured is adequate to also include your business equipment

Stock at the home

Please ensure that your contents sum insured is adequate to also include your stock

How many rooms are available to let to paying customers?

Number of rooms used for business (excluding bedrooms used for bed and breakfast)?

What is the maximum number of guests at one time?

Number of years trading as a bed and breakfast

Do you receive any visitors to your home in connection with your business(s), and if so roughly how many per week?

DO NOT USE THIS QUESTION. Please refer to "How many business callers visit the premises per month?"

Business Use

Separate Liability Premium

Nature of Business fee

Number of Visitors Fee:

Number Of Employees Fee

Confirmation

I confirm that I have fully read and understood:
(i) the introductory statement; and
(ii) the above questions and information.
I have answered the questions above accurately and completely to the best of my knowledge, information and belief.

If you do not tell us about changes or have provided incorrect information, the wrong terms and conditions may be quoted and we may be entitled to:

reject payment of a claim or a payment could be reduced, or

revise the premium and/or change any excess, or

revise the extent of cover or terms of this insurance.

In some circumstances your policy might be invalid, and you may not be entitled to a refund of premium

Please confirm the above statement

Claims 1yr Count

Claims 1yr Amount

Claims 2yr Count

Claims 2yr Amount

Claims 3yr Count

Claims 3yr Amount

Claims 4yr Count

Claims 4yr Amount

Claims 5yr Count

Claims 5yr Amount

Claims 6yr Count

Claims 6yr Amount

Claims 7yr Count

Claims 7yr Amount

Claims 8yr Count

Claims 8yr Amount

EOWClaims_1_Year_Count

EOW Claims 5yr Count

EOW Claims 5 Year Amount

Buildings - Claims Total Loading

Contents - Claims Total Loading

Rating Questions

Question Key - which insurer the rating adjustments apply to:

* Rating Adjustment = Applies to OIM Affinity
# Rating Adjustment = Applies to Castle
! Rating Adjustment = Applies to SAGIC

- - - - - Buildings Adjustments - - - - - (Values above 1 are loads, values below 1 are discounts)

*#! Rating Adjustment - Buildings Base Rate

*! Rating Adjustment - Postcode area Load %

*! Rating Adjustment - SAGIC/Affinity Postcode Area Load %

Added because we stopped applying Affinity Postcode loadings to SAGIC (November 17) resulting in SAGIC being far too cheap. We started applying Affinity postcode loads again (December 17)

*#! Rating Adjustment - Voluntary Excess Load

*#! Rating Adjustment - Accidental Damage Load %

*#! Rating Adjustment - Property Type Load %

*#! Rating Adjustment - Property Age Load %

#! Rating Adjustment - Property Age Load By Postcode

*! Rating Adjustment - Flood Re Buildings Load %

*#! Rating Adjustment - Wall Construction Load %

*#! Rating Adjustment - Roof Construction Load %

*#! Rating Adjustment - Flat Roof Load %

# Rating Adjustment - Number of Beds Load %

#! Rating Adjustment - Number of Beds by Postcode Load %

*#! Rating Adjustment - Age of Insured Load %

*! Rating Adjustment - Claims History Load %

*#! Rating Adjustment - Buildings & Contents Load %

# Rating Adjustment - Previous Subsidence

*#! Rating Adjustment - Listed Building %

*! Rating Adjustment - Sum Insured

!* Rating Adjustment - Occupation Load

* Rating Adjustment - Convictions Load

*! Rating Adjustment - Bed & Breakfast

*! Rating Adjustment - CCJ load

*! Rating Adjustment - Oil Heating Load %

Rating Adjustment - Total Load %

Rating Adjustment - Calculated Load

- - - - - Contents Adjustments - - - - - (Values above 1 are loads, values below 1 are discounts)

*#! Rating Adjustment - Contents Base Rate

*! Rating Adjustment - Postcode Area Load %

*! Rating Adjustment - SAGIC/Affinity Postcode Area Load %

*#! Rating Adjustment - Voluntary Excess Load %

*#! Rating Adjustment - Accidental Damage Load %

* Rating Adjustment - Commercial Cooking Load %

# Rating Adjustment - Number of Bedrooms Load %

*#! Rating Adjustment - Age of Insured Load %

#1 Rating Adjustment - Number of Beds by Postcode Load %

*! Rating Adjustment - Claims History Load %

*#! Rating Adjustment - Buildings and Contents Load %

*! Rating Adjustment - Contents SI Adjustment Load %

*! Rating Adjustment - Occupation Load

#1 Rating Adjustment - Property Age Load By Postcode

*! Rating Adjustment - Flood Re Contents Load %

*! Rating Adjustment - Property Type Load

* Rating Adjustment - Convictions Load

*! Rating Adjustment - Bed & Breakfast

*! Rating Adjustment - CCJ Load

Rating Adjustment - Total Load %

Rating Adjustment - Total Calculated Load

Contents SI Increase

- - - - - Contents Specified Adjustments - - - - - (Values above 1 are loads, values below 1 are discounts)

*! Rating Adjustment - Specified Items Base Rate

* Rating Adjustment - Postcode Load %

*! Rating Adjustment - SAGIC/Affinity Postcode Area Load %

*! Rating Adjustment - Voluntary Excess

* Rating Adjustment - Accidental Damage

! Rating Adjustment - SI Increase

*! Rating Adjustment - Claims History

*! Rating Adjustment - Age load

*! Rating Adjustment - Buildings & Contents Load

*! Rating Adjustment - Occupation Load

* Rating Adjustment - Convictions Load

*! Rating Adjustment - Bed & Breakfast

*! Rating Adjustment - CCJ

Rating Adjustment - Total Load %

Rating Adjustment - Total Calculated Load %

- - - - - SPP, PP, Money, Cycles Adjustments - - - - - (Values above 1 are loads, values below 1 are discounts)

*! Rating Adjustment - Personal Other Base Rate

*! Rating Adjustment - Items in Bank Base Rate

*! Rating Adjustment - Specified Cycles Base Rate

*! Rating Adjustment - Money base rate

*! Rating Adjustment - Personal Possessions Base Rate

*! Rating Adjustment - Deep Freeze Base Rate

*! Rating Adjustment - Specified Electronics Base Rate

* Rating Adjustment - Postcode Load

*! Rating Adjustment - SAGIC/Affinity Postcode Area Load %

* Rating Adjustment - Cycles Postcode Load

*! Rating Adjustment - Cycle SAGIC/Affinity Postcode Area Load %

*! Rating Adjustment - Claims History

*! Rating Adjustment - Age Load

*! Rating Adjustment - Buildings & Contents Load

*! Rating Adjustment - Occupation Load

*! Rating Adjustment - Bed & Breakfast

*! Rating Adjustment - CCJ Load

Rating Adjustment - Total Load

Rating Adjustment - Total Calculated Load

#! Is Price Match Allowed? (1 = Yes, 0 = No)

Additional POL Fee

Calculated Total Premium

Specified Items Referral

Specified Jewellery Referral

Specified Electronics Referral

DiscountNeeded

Oxygen Rating Questions

ContentsSpecifiedTempLoad

SpecifiedPersonalPossessionsTempLoad

UnSpecifiedPersonalPossessionsTempLoad

MoneyCreditCardsTempLoad

PedalCyclesTempLoad

Age

YearOfBirth

Convictions - Additional Excess

BuildingsTempLoad

ContentsTempLoad

Contents Security Code

A = 1
B = 2
etc

Total Jewellery Security Code

Individual Jewellery Security Code

Legals + Home Emergency Total

Total Castle Premium

Total OIM Premium

Total SAGIC Premium

NTU Adjustments

Main NTU Adjustment

Legal NTU Adjustment

Home Emergency NTU Adjustment

Contents NTU Adjustment

Claims Count

Claims Count Accidental Damage

Claims Count AD Audio Visual Equipment

Claims Count All Risk Losses

Claims Count Breakage Collapse Aerials

Claims Count Escape of Water Burst Pipes

Claims Count Fire, lightning, earthquake or explosion

Claims Count Fire by Arson

Claims Count Flood

Claims Count Freezer Contents

Claims Count Glass or Mirrors

Claims Count Impact

Claims Count Liability

Claims Count Loss of Metered Oil or Water

Claims Count Malicious Acts, Riot or Vandalism

Claims Count Money or Credit Cards

Claims Count Pedal Cycles

Claims Count Personal Possessions

Claims Count Storm

Claims Count Theft from the home

Claims Count Theft away from the home

Claims Count Subsidence Heave Landslip

Claims Count Sanitary Ware

Claims Count Underground Pipes Services

Claims Count Other

Specific Insurer Load

Loadings to force a specific insurer to quote using the Insured name Castle Test, OIM Affinity Test or SAGIC Test.

Previous Year - Buildings Discretionary Discount

This field is used to stop the discretionary discount discounting every time you update rates

Previous Year - Contents Discretionary Discount

Matrix Version

Added 05/10/17
Added so the new OIM Affinity Uplifts can apply correctly to MTA's. Quotes before 05/10/17 will use the old rates and quotes after will use new rates

DO NOT TOUCH - Buildings Notional Value for Castle Report

- for Castle reports - do not touch

DO NOT TOUCH - Contents Notional Value for Castle Report

- for Castle reports - do not touch

Price of Buildings / Contents inc/ex AD - SAGIC & Castle Only

Buildings Price inc AD (basic)

Buildings Price Ex AD (basic)

Contents Price inc AD (basic)

Contents Price Ex AD (basic)

TestCoverBox

Added 11 10 18

EOWExcessWorkAround

Work around to ticket: 22410. This applies to rule under HH any type, any insurer, quotation. Rule Number: 288234

Policy Minimum Premium

!DO NOT USE! - Additional Broker fee - To be used after 01/07/2020

CNO Ticket: 3351

FaradayReferredTrade

What Choice would have quoted on original figures

Original Premium For TRM

Producer name

Producer Commission Percent

Producer Commission

Cover Details

Additional Notes

Please note:
Only add information that is not covered in any questions as entering information here will trigger a referral.

Information entered here will cause this case to refer. Please ensure the details entered above are not covered within the question set.

Documents Only

Reason For Referral

Policy prefix to show on Documents

Broker Name

Broker Address

Broker Phone

Scheme Contact Email

OIM Affinity Ref

OIM Affinity Wording Ref

Policy Status (do not change)

1 = First Premium
2 = Adjustment
3 = Renewal
4 = Cancellation

Todays Date (Year)

Question needed for reports. Do not delete.

Index Linking Date

Index Linking - Contents

Index Linking - Buildings

Date For Uplifts

ARAGRef

ARAGWording

ARAGHEWording

ARAG Voucher Code

---- Broker Discount Percentage --- DO NOT USE

Emerald Life discounting field

Previous Years Insurer - For Docs

Added 10/06/2021 - Will be used on docs to hide sections when insurer doesn't change year by year.

Site Submitted

Client Email Address

Email enter again

Client Phone Number

Finance Version Control

Set in rating files

Finance Rate

Finance APR Rate

Finance Total Interest

Total premium (pre-finance)

Initial 10% upfront payment

First Instalment

Remaining 10 instalments

Total payable including finance

Excesses

Buildings Excess

SAGIC Buildings XS

Contents Excess

SAGIC Contents XS

Accidental Damage Contents XS

Question added 12/02/2020. Question went live 20/03/2020 - Ticket: 3224

Escape Of Water Excess

Subsidence Excess

Accidental Damage Excess

Unspecified valuables and personal possessions excess

Castle excess

Specified Valuables and personal possessions excess

Castle excess

Valuables and Personal Belongings Excess

OIM excess

Valuables And Personal Belongings Excess

SAGIC

Storm Excess

Flood Excess

Accidents to Domestic Staff

Legal Liability to the public Excess

Domestic Freezer cover Excess

Pedal Cycle Excess

Money and Credit Card cover Excess

Storm And Flood Excess

No longer used. Now Storm Excess and Flood Excess as at 17/07/15

ARAG Legals Excess

Set Underwriting Load	@	%	£0.00
Set Discretionary Discount	@	%	£0.00
Set Price Match	@	%	£0.00
Set Short Term Policy	@	%	£0.00
Set Voluntary Excess Discount (Castle)	@	%	£0.00
Set EOW Claims Load	@	%	£0.00
Set Claims Discount (Castle)	@	%	£0.00
Set Claims Load	@	%	£0.00
Set Bed and Breakfast Loads	@	%	£0.00
Set Affinity Postcode Discount	@	%	£0.00
Set Minimum Net Load	£		£0.00
Set Total Minimum Net Load	£		£0.00

Set Underwriting Load	@	%	£0.00
Set Discretionary Discount	@	%	£0.00
Set Price Match	@	%	£0.00
Set Short Term Policy	@	%	£0.00
Set Voluntary Excess Discount (Castle)	@	%	£0.00
Set EOW Claims Load	@	%	£0.00
Set Claims Discount (Castle)	@	%	£0.00
Set Claims Load	@	%	£0.00
Set Bed and Breakfast Loads	@	%	£0.00
Set Affinity Postcode Discount	@	%	£0.00
Set Minimum Net Load	£		£0.00


Total Premium (Net)			£0.00

+ IPT	@	%	£0.00
+ Policy Fee	£		£0.00

Total Premium			£0.00

Total Commission			£0.00
(Due From Broker)			£0.00