Agents Barn Conversion quote

Client details

Name*:
Date of birth*:
The name of the barn*:
Risk address*:
County:
Postcode*:
In which year was the barn converted?*:
How long in residence?
Please select the options that best describe the home
The walls are mainly*:
The roof construction is*:
Sums to be insured
Buildings (Minimum Sum Insured: £60,000)
Household contents (Minimum Sum Insured: £20,000)
Personal possessions (cover away from home) (Minimum Sum Insured: £2,000)
Specified items (cover away from home) (Items valued in excess of £1,500 or pedal cycles over £500)
Is there an intruder alarm?	Yes No
Any household claims within the last 5 years?*	Yes No If 'Yes' please complete the table below.

Please provide brief descriptions of any household claims made in the years below.

2011
Buildings
Contents
Amount paid
2010
Buildings
Contents
Amount paid
2009
Buildings
Contents
Amount paid
2008
Buildings
Contents
Amount paid
2007
Buildings
Contents
Amount paid
Has the home ever been flooded or exposed to risk of flooding?
Has the home been subject to a claim for subsidence?
Is the home free from cracks to external walls? (If 'NO' give details below)
Please complete any other relevant underwriting details to be taken into account in our quotation:

John Albion & Partners