{"id":10182,"date":"2023-01-03T13:03:28","date_gmt":"2023-01-03T12:03:28","guid":{"rendered":"https:\/\/www.emberjd.com\/?page_id=10182"},"modified":"2023-01-03T13:05:14","modified_gmt":"2023-01-03T12:05:14","slug":"unoccupied-block-of-flats-insurance-quote","status":"publish","type":"page","link":"https:\/\/www.emberjd.com\/request-quote\/unoccupied-block-of-flats-insurance-quote\/","title":{"rendered":"Unoccupied Block of Flats Insurance Quote"},"content":{"rendered":"<p>Please answer the questions carefully and to the best of your knowledge, as our quotation will be based on the details you provide. Incorrect information could lead to an increased premium, claim being declined or invalidate an insurance.<\/p>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_61' style='display:none'><div id='gf_61' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_61' id='gform_61'  action='\/wp-json\/wp\/v2\/pages\/10182#gf_61' data-formid='61' novalidate>\n        <div id='gf_progressbar_wrapper_61' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>4<\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_61_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_61' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_61_67\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_67\" ><h2 class=\"gsection_title\">Enter details of the insurance proposer, with option to add a joint proposer(s)<\/h2><\/li><li id=\"field_61_1\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon read-only gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_1\" ><label class='gfield_label gform-field-label' for='input_61_1'>Cover start date?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_1' id='input_61_1' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_61_1_date_format gfield_description_61_1\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_61_1_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_61_1' class='gform_hidden' value='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_61_1'>Quotes valid for up to <b>30 days<\/b><\/div><\/li><li id=\"field_61_5\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_5\" ><label class='gfield_label gform-field-label' for='input_61_5'>Select an insurance period?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_61_5' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='3 months' >3 months<\/option><option value='6 months' >6 months<\/option><option value='9 months' >9 months<\/option><\/select><\/div><\/li><li id=\"field_61_129\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_129\" ><label class='gfield_label gform-field-label' for='input_61_129'>Is the property owned by an individual or limited company?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_129' id='input_61_129' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Individual' >Individual<\/option><option value='Limited company' >Limited company<\/option><\/select><\/div><\/li><li id=\"field_61_131\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_131\" ><label class='gfield_label gform-field-label' for='input_61_131'>Full name of the limited company?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_131' id='input_61_131' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_61_96\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_96\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Enter details of the insurance proposer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_61_96'>\n                            <span id='input_61_96_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_96.2' id='input_61_96_2'    aria-required='false'   >\n                          <option value=''>Select from drop-down<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Miss.' >Miss.<\/option><option value='Ms.' >Ms.<\/option><option value='Executors of the late' >Executors of the late<\/option><option value='Dr.' >Dr.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_61_96_2' class='gform-field-label gform-field-label--type-sub '>Title<\/label>\n                                                  <\/span>\n                            <span id='input_61_96_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_96.3' id='input_61_96_3' value=''   aria-required='true'   placeholder='Full first name please'  \/>\n                                                    <label for='input_61_96_3' class='gform-field-label gform-field-label--type-sub '>First name<\/label>\n                                                <\/span>\n                            \n                            <span id='input_61_96_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_96.6' id='input_61_96_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_61_96_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_61_106\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_106\" ><label class='gfield_label gform-field-label' for='input_61_106'>Joint proposer(s)?<\/label><div class='ginput_container ginput_container_select'><select name='input_106' id='input_61_106' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_61_121\" class=\"gfield gfield--type-list gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_121\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Enter details of the joint insurance proposer(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><style type=\"text\/css\">\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons {\n\t\t\t\t\t\t\tvertical-align: middle !important;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img {\n\t\t\t\t\t\t\tbackground-color: transparent !important;\n\t\t\t\t\t\t\tbackground-position: 0 0;\n\t\t\t\t\t\t\tbackground-size: 16px 16px !important;\n\t\t\t\t\t\t\tbackground-repeat: no-repeat;\n\t\t\t\t\t\t\tborder: none !important;\n\t\t\t\t\t\t\twidth: 16px !important;\n\t\t\t\t\t\t\theight: 16px !important;\n\t\t\t\t\t\t\topacity: 0.5;\n\t\t\t\t\t\t\ttransition: opacity .5s ease-out;\n\t\t\t\t\t\t    -moz-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -webkit-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -o-transition: opacity .5s ease-out;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons a:hover img {\n\t\t\t\t\t\t\topacity: 1.0;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\t<\/style><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_121_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_121_col_2' class='gfield_list_col_even' \/><col id='gfield_list_121_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_121_col_4' class='gfield_list_col_even' \/><\/colgroup><thead><tr><th scope=\"col\">Title<\/th><th scope=\"col\">First name<\/th><th scope=\"col\">Surname<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_121_cell1' data-label='Title'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_61_121\" aria-label='Title, Row 1' data-aria-label-template='Title, Row {0}' type='text' name='input_121[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_121_cell2' data-label='First name'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_61_121\" aria-label='First name, Row 1' data-aria-label-template='First name, Row {0}' type='text' name='input_121[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_121_cell3' data-label='Surname'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_61_121\" aria-label='Surname, Row 1' data-aria-label-template='Surname, Row {0}' type='text' name='input_121[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 5)' onkeypress='gformAddListItem(this, 5)'><img data-src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' src='data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==' class='lazyload' \/><noscript><img data-src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' src='data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==' class='lazyload' \/><noscript><img src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/noscript><\/noscript><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 5)' onkeypress='gformDeleteListItem(this, 5)' style=\"visibility:hidden;\"><img data-src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' src='data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==' class='lazyload' \/><noscript><img data-src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' src='data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==' class='lazyload' \/><noscript><img src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/noscript><\/noscript><\/a><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_61_121'><p style=\"text-align:right;\"><b><font color=\"red\">Click  <big>&#10753;<\/big> sign to add more joint proposer(s)<\/font><\/b><\/p><\/div><\/li><li id=\"field_61_113\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_113\" ><label class='gfield_label gform-field-label' for='input_61_113'>Do you, or if applicable at least one joint proposer, reside in the United Kingdom or European Economic Area?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_113' id='input_61_113' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='I\/we reside in the United Kingdom (UK)' >I\/we reside in the United Kingdom (UK)<\/option><option value='I\/we reside in the European Economic Area (EEA)' >I\/we reside in the European Economic Area (EEA)<\/option><option value='I\/we reside outside of the UK and EEA (cannot quote)' >I\/we reside outside of the UK and EEA (cannot quote)<\/option><\/select><\/div><\/li><li id=\"field_61_21\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_21\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Email address?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_61_21_container'>\n                                <span id='input_61_21_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_21' id='input_61_21' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_61_21' class='gform-field-label gform-field-label--type-sub '>Enter email<\/label>\n                                <\/span>\n                                <span id='input_61_21_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_21_2' id='input_61_21_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_61_21_2' class='gform-field-label gform-field-label--type-sub '>Confirm email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_61_128\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_128\" ><label class='gfield_label gform-field-label' for='input_61_128'>Telephone number?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_128' id='input_61_128' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_61_128\"  \/><\/div><div class='gfield_description' id='gfield_description_61_128'>Please enter a valid phone number in UK format, starting 07, 01, 02 or +44, with no spaces<\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_61_24' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_61\").val(\"2\");  jQuery(\"#gform_61\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_61\").val(\"2\");  jQuery(\"#gform_61\").trigger(\"submit\",[true]); } ' \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_61_2_link' class='gform_save_link gform-theme-button gform-theme-button--secondary'  onclick='if(window[\"gf_submitting_61\"]){return false;}  if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;} jQuery(\"#gform_save_61\").val(1); jQuery(\"#gform_61\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_61\"]){return false;} if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;} jQuery(\"#gform_save_61\").val(1); jQuery(\"#gform_61\").trigger(\"submit\",[true]); }'> \ud83d\udcbe Save for later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_61_2' class='gform_page' data-js='page-field-id-24' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_61_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_61_70\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_70\" ><h2 class=\"gsection_title\">Enter details about the property to be insured<\/h2><\/li><li id=\"field_61_95\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield_has_postcode_lookup gfield_no_js\"  data-field-class=\"gfield_has_postcode_lookup gfield_no_js\" data-js-reload=\"field_61_95\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address of property to be insured?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_61_95'><big><b>Enter postcode, then select address from drop-down<\/b><\/big><br>\n<small>England, Wales & mainland Scotland addresses only<\/small><\/div>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip ginput_container_address gform-grid-row' id='input_61_95' ><span class=\"ginput_full ukpl_postcode_lookup_field\">\n    <span class=\"ukpl_postcode_lookup_container\">\n        <input type=\"text\" name=\"ukpl_postcode_lookup\" id=\"ukpl_postcode_lookup\" value=\"\" aria-required=\"false\">\n        <input type=\"submit\" class=\"js-ukpl-lookup-postcode\" value=\"Find Address\" \/>\n    <\/span>\n    <label for=\"ukpl_postcode_lookup\" class=\"ukpl_postcode_lookup_label\">Postcode<\/label>\n<\/span>\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_61_95_1_container' >\n                                        <input type='text' name='input_95.1' id='input_61_95_1' value=''   placeholder='-' aria-required='true'    \/>\n                                        <label for='input_61_95_1' id='input_61_95_1_label' class='gform-field-label gform-field-label--type-sub '>1st line<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_61_95_2_container' >\n                                        <input type='text' name='input_95.2' id='input_61_95_2' value=''     aria-required='false'   \/>\n                                        <label for='input_61_95_2' id='input_61_95_2_label' class='gform-field-label gform-field-label--type-sub '>2nd line<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_61_95_3_container' >\n                                    <input type='text' name='input_95.3' id='input_61_95_3' value=''    aria-required='true'    \/>\n                                    <label for='input_61_95_3' id='input_61_95_3_label' class='gform-field-label gform-field-label--type-sub '>Town \/ city<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_95.4' id='input_61_95_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_61_95_5_container' >\n                                    <input type='text' name='input_95.5' id='input_61_95_5' value=''    aria-required='true'    \/>\n                                    <label for='input_61_95_5' id='input_61_95_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_95.6' id='input_61_95_6' value='United Kingdom' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_61_132\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_132\" ><label class='gfield_label gform-field-label' for='input_61_132'>If you cannot select the full first line from the address lookup, add it here<\/label><div class='ginput_container ginput_container_text'><input name='input_132' id='input_61_132' type='text' value='' class='large'    placeholder='For example Manor Lodge, Flats 1 &amp; 2, or 50a &amp; 50b High Street'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_61_98\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_98\" ><label class='gfield_label gform-field-label' for='input_61_98'>Reason for unoccupancy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_98' id='input_61_98' class='medium gfield_select'  aria-describedby=\"gfield_description_61_98\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Up for sale' >Up for sale<\/option><option value='Owner moved into a care home' >Owner moved into a care home<\/option><option value='Living with a family member' >Living with a family member<\/option><option value='owner deceased' >Owner deceased<\/option><option value='inbetween lets' >Inbetween lets<\/option><option value='Renovation \/ refurbishment' >Renovation \/ refurbishment<\/option><option value='Holiday (cannot quote)' >Holiday (cannot quote)<\/option><option value='Damage from fire or flood (cannot quote)' >Damage from fire or flood (cannot quote)<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_61_98'>Select from drop down list below<\/div><\/li><li id=\"field_61_100\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_100\" ><label class='gfield_label gform-field-label' for='input_61_100'>Any works, refurbishment or renovations planned during the policy period that exceed \u00a350,000 when undertaken by an independent contractor or \u00a310,000 when undertaken by anyone other than an independent contractor?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_100' id='input_61_100' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='No' >No<\/option><option value='Yes (cannot quote)' >Yes (cannot quote)<\/option><\/select><\/div><\/li><li id=\"field_61_97\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_97\" ><label class='gfield_label gform-field-label' for='input_61_97'>Number of years unoccupied?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_97' id='input_61_97' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Under a year' >Under a year<\/option><option value='1 year' >1 year<\/option><option value='2 years' >2 years<\/option><option value='3 years' >3 years<\/option><option value='4 years' >4 years<\/option><option value='5 years' >5 years<\/option><option value='6 years and over (cannot quote)' >6 years and over (cannot quote)<\/option><\/select><\/div><\/li><li id=\"field_61_120\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_120\" ><label class='gfield_label gform-field-label' for='input_61_120'>Please advise us of the reason for the long length of time unccupancy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_120' id='input_61_120' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_61_94\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_94\" ><label class='gfield_label gform-field-label' for='input_61_94'>Approximate year property built?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_61_94' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_61_28\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_28\" ><label class='gfield_label gform-field-label' for='input_61_28'>Type of property?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_28' id='input_61_28' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Block of flats' >Block of flats<\/option><option value='Detached house' >Detached house<\/option><option value='Detached bungalow' >Detached bungalow<\/option><option value='Semi detached house' >Semi detached house<\/option><option value='Semi detached bungalow' >Semi detached bungalow<\/option><option value='End terrace house' >End terrace house<\/option><option value='Mid terrace house' >Mid terrace house<\/option><option value='End terrace bungalow' >End terrace bungalow<\/option><option value='Mid terrace bungalow' >Mid terrace bungalow<\/option><option value='Individual flat' >Individual flat<\/option><option value='Individual maisonette' >Individual maisonette<\/option><\/select><\/div><\/li><li id=\"field_61_130\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_130\" ><label class='gfield_label gform-field-label' for='input_61_130'>Total number of flats in the building \/ block?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_130' id='input_61_130' type='number' step='any' min='2'  value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_61_130\" \/><div class='gfield_description instruction ' id='gfield_instruction_61_130'>Please enter a number greater than or equal to <strong>2<\/strong>.<\/div><\/div><\/li><li id=\"field_61_118\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_118\" ><label class='gfield_label gform-field-label' for='input_61_118'>Do you have to insure the buildings your flat or maisonette under the terms of your lease?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_118' id='input_61_118' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><option value='No (cannot quote)' >No (cannot quote)<\/option><\/select><\/div><\/li><li id=\"field_61_32\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_32\" ><label class='gfield_label gform-field-label' for='input_61_32'>Number of bedrooms?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_32' id='input_61_32' type='number' step='any' min='0' max='6' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_61_32\" \/><\/div><\/li><li id=\"field_61_77\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_77\" ><label class='gfield_label gform-field-label' for='input_61_77'>Is the property in a condition in which it could be lived in as a home?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_77' id='input_61_77' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><option value='No (cannot quote)' >No (cannot quote)<\/option><\/select><\/div><\/li><li id=\"field_61_29\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_29\" ><label class='gfield_label gform-field-label' for='input_61_29'>Construction of the external walls?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_29' id='input_61_29' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Brick' >Brick<\/option><option value='Stone' >Stone<\/option><option value='Concrete' >Concrete<\/option><option value='Timber framed with brick walls' >Timber framed with brick walls<\/option><option value='Timber framed with cedar cladding' >Timber framed with cedar cladding<\/option><option value='Flint' >Flint<\/option><option value='Cob' >Cob<\/option><option value='Prefabricated (cannot quote)' >Prefabricated (cannot quote)<\/option><\/select><\/div><\/li><li id=\"field_61_30\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_30\" ><label class='gfield_label gform-field-label' for='input_61_30'>Main construction of the roof?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_30' id='input_61_30' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Tile or slate' >Tile or slate<\/option><option value='Zinc' >Zinc<\/option><option value='Rubber (EPDM)' >Rubber (EPDM)<\/option><option value='Single ply membrane' >Single ply membrane<\/option><option value='Felt over timber' >Felt over timber<\/option><option value='Fibre cement sheeting' >Fibre cement sheeting<\/option><option value='Thatch (cannot quote)' >Thatch (cannot quote)<\/option><\/select><\/div><\/li><li id=\"field_61_31\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_31\" ><label class='gfield_label gform-field-label' for='input_61_31'>Approximate percentage of any flat roof?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_31' id='input_61_31' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='No flat roof' >No flat roof<\/option><option value='Up to 20%' >Up to 20%<\/option><option value='Up to 30%' >Up to 30%<\/option><option value='Up to 40%' >Up to 40%<\/option><option value='Up to 50%' >Up to 50%<\/option><option value='Up to 100%' >Up to 100%<\/option><\/select><\/div><\/li><li id=\"field_61_33\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_33\" ><label class='gfield_label gform-field-label' for='input_61_33'>Is the property a listed building?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_61_33' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_61_40' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_61\").val(\"1\");  jQuery(\"#gform_61\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_61\").val(\"1\");  jQuery(\"#gform_61\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_61_40' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_61\").val(\"3\");  jQuery(\"#gform_61\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_61\").val(\"3\");  jQuery(\"#gform_61\").trigger(\"submit\",[true]); } ' \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_61_3_link' class='gform_save_link gform-theme-button gform-theme-button--secondary'  onclick='if(window[\"gf_submitting_61\"]){return false;}  if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;} jQuery(\"#gform_save_61\").val(1); jQuery(\"#gform_61\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_61\"]){return false;} if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;} jQuery(\"#gform_save_61\").val(1); jQuery(\"#gform_61\").trigger(\"submit\",[true]); }'> \ud83d\udcbe Save for later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_61_3' class='gform_page' data-js='page-field-id-40' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_61_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_61_72\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_72\" ><h2 class=\"gsection_title\">Buildings insurance<\/h2><\/li><li id=\"field_61_122\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_122\" ><label class='gfield_label gform-field-label' for='input_61_122'>REBUILDING cost of the property \u00a3?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_122' id='input_61_122' type='text' step='any' min='75000'  value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_61_122 gfield_description_61_122\" \/><\/div><div class='gfield_description' id='gfield_description_61_122'>Input your sum insured<\/div><\/li><li id=\"field_61_47\" class=\"gfield gfield--type-select field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_47\" ><label class='gfield_label gform-field-label' for='input_61_47'>Contents sum insured?<\/label><div class='ginput_container ginput_container_select'><select name='input_47' id='input_61_47' class='medium gfield_select'  aria-describedby=\"gfield_description_61_47\"   aria-invalid=\"false\" ><option value='Not required' selected='selected'>Not required<\/option><option value='\u00a33,000' >\u00a33,000<\/option><option value='\u00a35,000' >\u00a35,000<\/option><option value='\u00a37,500' >\u00a37,500<\/option><option value='\u00a310,000' >\u00a310,000<\/option><option value='\u00a312,500' >\u00a312,500<\/option><option value='\u00a315,000' >\u00a315,000<\/option><option value='\u00a317,500' >\u00a317,500<\/option><option value='\u00a320,000' >\u00a320,000<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_61_47'>If required select your sum insured<\/div><\/li><li id=\"field_61_111\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_111\" ><label class='gfield_label gform-field-label' for='input_61_111'>Level of cover options<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_111' id='input_61_111' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'>Level 1: Fire, smoke, lightning, explosion, earthquake, aircraft impact.\nLevel 2: Fire, smoke, lightning, explosion, earthquake, aircraft impact, storm, flood, collision by any vehicle or animal, subsidence, heave, landslip.\nLevel 3: Fire, smoke, lightning, explosion, earthquake, aircraft impact, storm, flood, escape of water from fixed water tanks, apparatus or pipes, escape of oil from a fixed domestic oil-fired heating installation and smoke damage caused by a fault in any fixed domestic heating installation, theft or attempted theft, collision by any vehicle or animal, malicious damage, subsidence, heave, landslip.<\/textarea><\/div><\/li><li id=\"field_61_112\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_112\" ><label class='gfield_label gform-field-label' for='input_61_112'>Select the level of cover you require?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_112' id='input_61_112' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Level 1' >Level 1<\/option><option value='Level 2' >Level 2<\/option><option value='Level 3' >Level 3<\/option><\/select><\/div><\/li><li id=\"field_61_110\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_110\" ><label class='gfield_label gform-field-label' for='input_61_110'>Voluntary excess (with premium discount)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_110' id='input_61_110' class='medium gfield_select'  aria-describedby=\"gfield_description_61_110\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='\u00a3100' >\u00a3100<\/option><option value='\u00a3250' >\u00a3250<\/option><option value='\u00a3500' >\u00a3500<\/option><option value='\u00a31,000' >\u00a31,000<\/option><option value='Zero' >Zero<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_61_110'>In addition to the compulsory excesses<\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_61_79' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_61\").val(\"2\");  jQuery(\"#gform_61\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_61\").val(\"2\");  jQuery(\"#gform_61\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_61_79' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_61\").val(\"4\");  jQuery(\"#gform_61\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_61\").val(\"4\");  jQuery(\"#gform_61\").trigger(\"submit\",[true]); } ' \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_61_4_link' class='gform_save_link gform-theme-button gform-theme-button--secondary'  onclick='if(window[\"gf_submitting_61\"]){return false;}  if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;} jQuery(\"#gform_save_61\").val(1); jQuery(\"#gform_61\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_61\"]){return false;} if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;} jQuery(\"#gform_save_61\").val(1); jQuery(\"#gform_61\").trigger(\"submit\",[true]); }'> \ud83d\udcbe Save for later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_61_4' class='gform_page' data-js='page-field-id-79' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_61_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_61_75\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_75\" ><h2 class=\"gsection_title\">About proposer(s) and the property to be insured<\/h2><div class='gsection_description' id='gfield_description_61_75'><a href=\"javascript:;\" onclick=\"window.open('final-details','myWin','scrollbars=yes,width=590,height=400');\"><img decoding=\"async\" class=\"alignright size-full wp-image-1166 lazyload\" title=\"Information\" alt=\"Information\" data-src=\"https:\/\/www.emberjd.com\/wp-content\/uploads\/2012\/02\/information symbol.jpg\" width=\"10\" height=\"15\" style=\"--smush-placeholder-width: 10px; --smush-placeholder-aspect-ratio: 10\/15;margin-top: -25px; margin-right: -10px;\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\"><noscript><img decoding=\"async\" class=\"alignright size-full wp-image-1166\" title=\"Information\" alt=\"Information\" src=\"https:\/\/www.emberjd.com\/wp-content\/uploads\/2012\/02\/information symbol.jpg\" width=\"10\" height=\"15\" style=\"margin-top: -25px; margin-right: -10px;\"><\/noscript><\/a><\/div><\/li><li id=\"field_61_62\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_62\" ><label class='gfield_label gform-field-label' for='input_61_62'>Any unspent criminal conviction(s) or prosecution(s) pending?<\/label><div class='ginput_container ginput_container_select'><select name='input_62' id='input_61_62' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes (give details in box below)' >Yes (give details in box below)<\/option><\/select><\/div><\/li><li id=\"field_61_84\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_84\" ><label class='gfield_label gform-field-label' for='input_61_84'>Please give details<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_61_84' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_61_63\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_63\" ><label class='gfield_label gform-field-label' for='input_61_63'>Ever been declared bankrupt, have any CCJs, IVAs or arrangements with creditors?<\/label><div class='ginput_container ginput_container_select'><select name='input_63' id='input_61_63' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes (give details in box below)' >Yes (give details in box below)<\/option><\/select><\/div><\/li><li id=\"field_61_85\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_85\" ><label class='gfield_label gform-field-label' for='input_61_85'>Please give details<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_61_85' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_61_64\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_64\" ><label class='gfield_label gform-field-label' for='input_61_64'>Ever had a proposal declined, had a policy cancelled by an insurer, renewal refused or had any special terms imposed?<\/label><div class='ginput_container ginput_container_select'><select name='input_64' id='input_61_64' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes (give details in box below)' >Yes (give details in box below)<\/option><\/select><\/div><\/li><li id=\"field_61_86\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_86\" ><label class='gfield_label gform-field-label' for='input_61_86'>Please give details<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_61_86' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_61_61\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_61\" ><label class='gfield_label gform-field-label' for='input_61_61'>Has the property previously flooded or are you aware of a risk of flooding in the locality?<\/label><div class='ginput_container ginput_container_select'><select name='input_61' id='input_61_61' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes (give details in box below)' >Yes (give details in box below)<\/option><\/select><\/div><\/li><li id=\"field_61_87\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_87\" ><label class='gfield_label gform-field-label' for='input_61_87'>Please give details<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_61_87' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_61_59\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_59\" ><label class='gfield_label gform-field-label' for='input_61_59'>Has the property ever been damaged by subsidence, ground heave or landslip, monitored for subsidence, survey reported settlement or movement, showing visible signs of cracking or within an area subject to subsidence or mining (past or present)?<\/label><div class='ginput_container ginput_container_select'><select name='input_59' id='input_61_59' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes (give details in box below)' >Yes (give details in box below)<\/option><\/select><\/div><\/li><li id=\"field_61_89\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_89\" ><label class='gfield_label gform-field-label' for='input_61_89'>Please give details<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_61_89' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_61_65\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_65\" ><label class='gfield_label gform-field-label' for='input_61_65'>Made any claims under home insurance policy for this or any other property or any incidents of damage or loss not insured, in the last 5 years?<\/label><div class='ginput_container ginput_container_select'><select name='input_65' id='input_61_65' class='medium gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes (give details in box below)' >Yes (give details in box below)<\/option><\/select><\/div><\/li><li id=\"field_61_91\" class=\"gfield gfield--type-list gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_61_91\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please give details<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_61_91'><p style=\"text-align:center;\"><b><font color=\"red\"><big>If you do not have all the information you can save and return later, as incomplete answers will mean we cannot quote<\/big><\/font><\/b><\/p>\n<p style=\"text-align:right;\"><b><font color=\"red\">Click  <big>&#10753;<\/big> to add more row(s)<\/font><\/b><\/p><\/div><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_91_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_91_col_2' class='gfield_list_col_even' \/><col id='gfield_list_91_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_91_col_4' class='gfield_list_col_even' \/><\/colgroup><thead><tr><th scope=\"col\">Month \/ Year<\/th><th scope=\"col\">Type of Claim \/ Brief Description<\/th><th scope=\"col\">Cost \u00a3<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_91_cell1' data-label='Month \/ Year'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_61_91\" aria-label='Month \/ Year, Row 1' data-aria-label-template='Month \/ Year, Row {0}' type='text' name='input_91[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_91_cell2' data-label='Type of Claim \/ Brief Description'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_61_91\" aria-label='Type of Claim \/ Brief Description, Row 1' data-aria-label-template='Type of Claim \/ Brief Description, Row {0}' type='text' name='input_91[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_91_cell3' data-label='Cost \u00a3'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_61_91\" aria-label='Cost \u00a3, Row 1' data-aria-label-template='Cost \u00a3, Row {0}' type='text' name='input_91[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 5)' onkeypress='gformAddListItem(this, 5)'><img data-src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' src='data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==' class='lazyload' \/><noscript><img data-src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' src='data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==' class='lazyload' \/><noscript><img src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/noscript><\/noscript><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 5)' onkeypress='gformDeleteListItem(this, 5)' style=\"visibility:hidden;\"><img data-src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' src='data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==' class='lazyload' \/><noscript><img data-src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' src='data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==' class='lazyload' \/><noscript><img src='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/noscript><\/noscript><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_61_117\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_61_117\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_61_117'>IMPORTANT INFORMATION THAT MUST BE READ IN FULL<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_117' id='input_61_117' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'>The information contained in this Statement of Fact forms the basis of your policy and is fundamental to the risk assumed by the Insurers. You must notify Ember JD Insurance Brokers immediately if any of the above details are incorrect as your cover might be invalidated if you do not.\nMisrepresentation\nWe declare that to the best of my knowledge and belief the information I\/We have provided in connection with this proposal to Ember JD Insurance Brokers, whether in my own hand or not, is true and complete and I\/We have not withheld or misrepresented any information. I\/We ask underwriters to act upon the information provided and issue a contract of insurance between us and I\/We agree to accept underwriter\u2019s policy terms, conditions and exclusions. I\/We consent to the seeking of information from other insurers to check the answers I\/We have provided and I\/We authorise the giving of such information for such purposes. I\/We understand that if I\/We have withheld or misrepresented any of the information contained in this proposal, underwriters may be entitled to void the insurance.\nData Protection Act 1998\nBy accepting this Statement of Fact you consent to Ember JD Insurance Brokers using the information we may hold about you for the purpose of providing insurance and handling claims, if any, and to process sensitive personal data about you where this is necessary (for example, health information or criminal convictions). This may mean we have to give some details to third parties involved in providing insurance cover. These may include insurance carriers, third party claims adjusters, fraud detection and prevention services, reinsurance companies and insurance regulatory authorities. Where such sensitive personal information relates to anyone other than you, you must obtain the explicit consent of the person to whom the information relates both to the disclosure of such information to us and its use by us as set out above. The information provided will be treated in confidence and in compliance with the Data Protection Act 1998. You have the right to apply for a copy of you information (for which we may charge a small fee) and to have any inaccuracies corrected.\nBasis of Cover\nI understand that my acceptance of this Statement of Fact does not bind me to complete the insurance but agree that, should a contract of insurance be concluded, this Statement of Fact and the statements made in it and the information provided in connection with it will be relied upon by the underwriters in deciding whether to accept this insurance.\nYour records\nYou should keep a record (including copies of any letters) of all information supplied to Ember JD Insurance Brokers for the purpose of entering into this insurance.\nChange in Circumstance\nYou must inform Ember JD Insurance Brokers of any change in circumstances which may affect this insurance. If you are in any doubt you should consult Ember JD Insurance Brokers.\nE.U. Disclosure Clause (UK)\nNotice to the Proposer \/ Insured: The parties are free to choose the law applicable to this insurance contract. Unless specifically agreed to the contrary this insurance shall be subject to English Law.\nComplaints\nAny enquiry or complaint should be addressed in the first instance to your broker, Ember JD Insurance Brokers. The process for complaining directly to Lloyds can be found in the Complaints section of your Policy Wording.\nThe Financial Ombudsman\nIf you are still not satisfied with the way a complaint has been dealt with you may ask The Financial Ombudsman to review your case without prejudice to your rights in law. You can contact The Financial Ombudsman at:\nThe Financial Ombudsman Service\nExchange Tower\nLondon\nE14 9SR\nTelephone: 0800 023 4567\nwww.financial-ombudsman.org.uk.<\/textarea><\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_61' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_61\"]){return false;}  if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_61\"]){return false;} if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;}  jQuery(\"#gform_61\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_61' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_61\"]){return false;}  if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_61\"]){return false;} if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;}  jQuery(\"#gform_61\").trigger(\"submit\",[true]); }' \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_61_footer_link' class='gform_save_link gform-theme-button gform-theme-button--secondary'  onclick='if(window[\"gf_submitting_61\"]){return false;}  if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;} jQuery(\"#gform_save_61\").val(1); jQuery(\"#gform_61\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_61\"]){return false;} if( !jQuery(\"#gform_61\")[0].checkValidity || jQuery(\"#gform_61\")[0].checkValidity()){window[\"gf_submitting_61\"]=true;} jQuery(\"#gform_save_61\").val(1); jQuery(\"#gform_61\").trigger(\"submit\",[true]); }'> \ud83d\udcbe Save for later<\/a><input type='hidden' name='gform_ajax' value='form_id=61&amp;title=&amp;description=&amp;tabindex=0&amp;theme=legacy' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_61' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='61' \/>\n            <input type='hidden' class='gform_hidden' name='gform_save' id='gform_save_61' value='' \/>\n                             <input type='hidden' class='gform_hidden' name='gform_resume_token' id='gform_resume_token_61' value='' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_61' value='WyJbXSIsIjZhZWE4ZTRjZTgzMjhhMDEyZGI4NjRlOGRkMTdmM2NlIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_61' id='gform_target_page_number_61' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_61' id='gform_source_page_number_61' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_61' id='gform_ajax_frame_61' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 61, 'https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_61').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_61');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_61').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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