Ember JD >> Sharer's Content and Liability


Applicant Details
Required fields*
Title
Firstname(s)*
Surname*
Date of Birth (dd/mm/yyyy)
Preferred Contact Day / Time
Contact Tel. phone

Property Details
Name of the block
Address of the block
Postcode of the block
Buildings sum insured
How many storeys
How many blocks
Is the building:	Purpose built	or	Converted
Approximate year block built:
Is the Property permanently occupied?	Yes	No
Do you have an Alarm?	Yes	No
If Yes, was it installed by NACOSS approved installer and is it regularly maintained?
Yes	No
Do You have a Safe?	Yes	No
Previous Insurers of this Property whilst in your ownership, if None give reason
Insurance Required From
Please Specify the Amounts you required to be insured below:
Buildings : Sum insured
Contents : Sum Insured
Personal Possessions
Do You Require Accidental Damage to Buildings?	Yes	No
Would you like to reduce the excess on Contents from £100 to £50 ?
	Yes	No
Please list Items, Pairs or Sets covered under Section B & C(Contents & Fine Arts etc) with a value of more than £15,000
Please list Items, Pairs or Sets covered under Section D(Personal Effects) with a value of more than £5,000
Would you like to include Family Legal Protection and Insured Property Assistance
	Yes	No
I the proposer confirm the following: The Property is of standard construction, built of brick, stone or concrete and is in a good state of repair. The property is in an area free from flooding and normally free from subsidence, heave, landslide or coastal river erosion. The Property is free from signs of damage due to subsidence, heave or landslide (such as external or internal cracks). The Property has not been monitored (and is not being monitored), for subsidence, heave or landslide. The Property has not been the subject of a survey which mentions settlement or movement of buildings. (If you cannot confirm this please provide details below). All external doors are fitted with 5 lever mortice deadlocks and all ground floor windows, fanlights skylights and patio doors have key operated locks. Neither I, or any member of my family living with me has been refused Insurance or had any special terms and conditions imposed, been convicted of, or has prosecutions pending for any criminal acts (other than motor offences). Neither I, or any member of my family living with me has made a claim within the last 5 years or had a claim pending against them. If you are unable to confirm any of the above statements please provide d
If you are unable to confirm any of the above statements please provide details :-
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