Property Owner Insurance Quote

Please fill out the quote form below with accurate and complete details.

Client Details

Full Name *

Email Address

Phone

Date of Birth

Risk Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

INSURED QUESTIONS

Have the private individual(s) or business to be insured, including a) any Director, Principal or Partner of the business or; b) any person(s) with a beneficial interest of 25% or more in the business: If the Insured is now the administrators please complete below to the best of your knowledge for the previous owners.

has ever had a proposal refused or declined or ever had an insurance cancelled, renewal refused or had special terms imposed?YesNo

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has ever been convicted of or charged (but not yet tried) with a breach of any health and safety legislation or any criminal offence other than parking or speeding offences or offences which are not spent under Rehabilitation of Offers Act 1974?YesNo

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has been the subject of a County Court Judgement and/or ever been cited in any unsatisfied court order (or the Scottish equivalent) within the last 10 years?YesNo

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has been subject to bankruptcy or insolvency orders which are either outstanding or have been discharged for less than 15 years?YesNo

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has been subject to an individual voluntary arrangement with creditors, voluntary liquidation, a winding up or administration order, or administrative receivership proceedings within the last 15 years?YesNo

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has been subject to a Health and Safety Executive (HSE) investigation?YesNo

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has been disqualified from acting as a Company Director?YesNo

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