Agents Thatched Home quote

Client details

Name*:
Date of birth*:
The name or number of the home*:
Risk address*:
County:
Postcode*:
In which year was the home built?*:
How long in residence?
Please select the options that best describe the home
The walls are mainly*:
Please describe the construction of the walls of your home where more than one method or material is used:
The thatched roof of the home is mainly*:
Please describe the construction of the roof of your home where more than one method or material is used:
Please tell us about the methods of heating used in the home
Are the chimneys used?*	Yes No
Are any chimneys used for open fires?*	Yes No
Are any chimneys used for solid fuel stoves?*	Yes No
What is the main method of heating?*
Please also complete and send us the supplementary Questionnaire for Thatched Properties* which can be found in the document library.*
Sums to be insured
Buildings
Household contents
Personal possessions away from home
Specified items away from home
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)
Is the property detached?	Yes No
Please complete any other relevant underwriting details to be taken into account in our quotation:

John Albion & Partners