{"id":7027,"date":"2015-01-26T14:22:27","date_gmt":"2015-01-26T13:22:27","guid":{"rendered":"https:\/\/www.emberjd.com\/?page_id=7027"},"modified":"2024-01-12T11:37:08","modified_gmt":"2024-01-12T11:37:08","slug":"flats-insurance-quote","status":"publish","type":"page","link":"https:\/\/www.emberjd.com\/request-quote\/flats-insurance-quote\/","title":{"rendered":"Flats Insurance Quote"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7027\" class=\"elementor elementor-7027\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1890c34f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1890c34f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5f33aa37\" data-id=\"5f33aa37\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-24a6f2bd elementor-widget elementor-widget-text-editor\" data-id=\"24a6f2bd\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 24-04-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p><strong>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.<\/strong><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d9a1b56 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d9a1b56\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-38c90c5\" data-id=\"38c90c5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-35bfbd2 elementor-widget elementor-widget-shortcode\" data-id=\"35bfbd2\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><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_4' style='display:none'><div id='gf_4' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/wp-json\/wp\/v2\/pages\/7027#gf_4' data-formid='4' novalidate>\n        <div id='gf_progressbar_wrapper_4' 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> - Insurance proposer\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_4_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_4_67\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_67\" ><h2 class=\"gsection_title\">Enter details about the insurance proposer<\/h2><\/li><li id=\"field_4_1\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon read-only gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_1\" ><label class='gfield_label gform-field-label' for='input_4_1'>Renewal or 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_4_1' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_4_1_date_format gfield_description_4_1\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_1_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_1' class='gform_hidden' value='https:\/\/www.emberjd.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_4_1'>Quotes valid for up to <b>30 days<\/b><\/div><\/li><li id=\"field_4_106\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_106\" ><label class='gfield_label gform-field-label' for='input_4_106'>Is the property insured in name of a sole freeholder, joint freeholders, residents or management 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_106' id='input_4_106' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Sole freeholder' >Sole freeholder<\/option><option value='Joint freeholders' >Joint freeholders<\/option><option value='Residents association or management company' >Residents association or management company<\/option><option value='Leaseholder(s) with no share of the freehold - cannot quote' >Leaseholder(s) with no share of the freehold - cannot quote<\/option><\/select><\/div><\/li><li id=\"field_4_107\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_107\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Sole freeholder<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_4_107'>\n                            <span id='input_4_107_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_107.2' id='input_4_107_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='Dr.' >Dr.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_4_107_2' class='gform-field-label gform-field-label--type-sub '>Title<\/label>\n                                                  <\/span>\n                            <span id='input_4_107_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_107.3' id='input_4_107_3' value=''   aria-required='true'   placeholder='First name in full'  \/>\n                                                    <label for='input_4_107_3' class='gform-field-label gform-field-label--type-sub '>First name<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_107_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_107.6' id='input_4_107_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_107_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_4_101\" class=\"gfield gfield--type-list gfield--input-type-list gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_101\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Names of joint freeholders<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_101_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_101_col_2' class='gfield_list_col_even' \/><col id='gfield_list_101_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_101_col_4' class='gfield_list_col_even' \/><\/colgroup><thead><tr><th scope=\"col\">Title<\/th><th scope=\"col\">First name in full<\/th><th scope=\"col\">Surname (click plus sign to add more freeholder(s)<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_101_cell1' data-label='Title'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_101\" aria-label='Title, Row 1' data-aria-label-template='Title, Row {0}' type='text' name='input_101[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_101_cell2' data-label='First name in full'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_101\" aria-label='First name in full, Row 1' data-aria-label-template='First name in full, Row {0}' type='text' name='input_101[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_101_cell3' data-label='Surname (click plus sign to add more freeholder(s)'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_101\" aria-label='Surname (click plus sign to add more freeholder(s), Row 1' data-aria-label-template='Surname (click plus sign to add more freeholder(s), Row {0}' type='text' name='input_101[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 6)' onkeypress='gformAddListItem(this, 6)'><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 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><\/noscript><\/noscript><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 6)' onkeypress='gformDeleteListItem(this, 6)' ><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 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><\/noscript><\/noscript><\/a><\/td><\/tr><tr class='gfield_list_row_even gfield_list_group'><td class='gfield_list_cell gfield_list_101_cell1' data-label='Title'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_101\" aria-label='Title, Row 2' data-aria-label-template='Title, Row {0}' type='text' name='input_101[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_101_cell2' data-label='First name in full'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_101\" aria-label='First name in full, Row 2' data-aria-label-template='First name in full, Row {0}' type='text' name='input_101[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_101_cell3' data-label='Surname (click plus sign to add more freeholder(s)'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_101\" aria-label='Surname (click plus sign to add more freeholder(s), Row 2' data-aria-label-template='Surname (click plus sign to add more freeholder(s), Row {0}' type='text' name='input_101[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 6)' onkeypress='gformAddListItem(this, 6)'><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 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><\/noscript><\/noscript><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 6)' onkeypress='gformDeleteListItem(this, 6)' ><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 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><\/noscript><\/noscript><\/a><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_4_101'><p style=\"text-align:right;\"><b><font color=\"red\">CLICK  <big>&#10753;<\/big> BUTTON TO ADD MORE JOINT FREEHOLDER(S) NAMES<\/font><\/b><\/p><\/div><\/li><li id=\"field_4_78\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_78\" ><label class='gfield_label gform-field-label' for='input_4_78'>Name of the residents association or management 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_78' id='input_4_78' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_4_127\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_127\" ><label class='gfield_label gform-field-label' for='input_4_127'>Do you recharge the cost of the buildings insurance to the leaseholders?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_127'>Excluding anyone named as a policyholder<br><div align=\"left\"><a href=\"https:\/\/www.emberjd.com\/multi-occupancy-buildings-insurance-reforms\/\" target=\"_blank\"><big>&#8505;<\/big><\/a><\/div><\/div><div class='ginput_container ginput_container_select'><select name='input_127' id='input_4_127' class='medium gfield_select'  aria-describedby=\"gfield_description_4_127\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_4_128\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_128\" ><label class='gfield_label gform-field-label' for='input_4_128'>Do you recharge the cost of the buildings insurance to the leaseholders?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_128'>Excluding anyone named as a policyholder<br><div align=\"left\"><a href=\"https:\/\/www.emberjd.com\/multi-occupancy-buildings-insurance-reforms\/\" target=\"_blank\"><big>&#8505;<\/big><\/a><\/div><\/div><div class='ginput_container ginput_container_select'><select name='input_128' id='input_4_128' class='medium gfield_select'  aria-describedby=\"gfield_description_4_128\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_4_21\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_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_4_21_container'>\n                                <span id='input_4_21_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_21' id='input_4_21' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_4_21' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_4_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_4_21_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_4_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_4_20\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_20\" ><label class='gfield_label gform-field-label' for='input_4_20'>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_20' id='input_4_20' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_4_20\"  \/><\/div><div class='gfield_description' id='gfield_description_4_20'>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_4_24' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_4\").val(\"2\");  jQuery(\"#gform_4\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_4\").val(\"2\");  jQuery(\"#gform_4\").trigger(\"submit\",[true]); } ' \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_4_2_link' class='gform_save_link gform-theme-button gform-theme-button--secondary'  onclick='if(window[\"gf_submitting_4\"]){return false;}  if( !jQuery(\"#gform_4\")[0].checkValidity || jQuery(\"#gform_4\")[0].checkValidity()){window[\"gf_submitting_4\"]=true;} jQuery(\"#gform_save_4\").val(1); jQuery(\"#gform_4\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_4\"]){return false;} if( !jQuery(\"#gform_4\")[0].checkValidity || jQuery(\"#gform_4\")[0].checkValidity()){window[\"gf_submitting_4\"]=true;} jQuery(\"#gform_save_4\").val(1); jQuery(\"#gform_4\").trigger(\"submit\",[true]); }'> \ud83d\udcbe Save for later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_2' class='gform_page' data-js='page-field-id-24' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_4_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_4_70\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_70\" ><h2 class=\"gsection_title\">Enter details about the property to be insured and the occupancy<\/h2><\/li><li id=\"field_4_105\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible gfield_has_postcode_lookup gfield_no_js\"  data-field-class=\"gfield_has_postcode_lookup gfield_no_js\" data-js-reload=\"field_4_105\" ><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_4_105'><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_4_105' ><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_4_105_1_container' >\n                                        <input type='text' name='input_105.1' id='input_4_105_1' value=''   placeholder='-' aria-required='true'    \/>\n                                        <label for='input_4_105_1' id='input_4_105_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_4_105_2_container' >\n                                        <input type='text' name='input_105.2' id='input_4_105_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_105_2' id='input_4_105_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_4_105_3_container' >\n                                    <input type='text' name='input_105.3' id='input_4_105_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_105_3' id='input_4_105_3_label' class='gform-field-label gform-field-label--type-sub '>Town \/ city<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_105.4' id='input_4_105_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_105_5_container' >\n                                    <input type='text' name='input_105.5' id='input_4_105_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_105_5' id='input_4_105_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_105.6' id='input_4_105_6' value='United Kingdom' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_4_126\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_126\" ><label class='gfield_label gform-field-label' for='input_4_126'>If you cannot select the complete first line of the property address, add it here, otherwise if correct, leave blank<\/label><div class='ginput_container ginput_container_text'><input name='input_126' id='input_4_126' type='text' value='' class='large'    placeholder='For example Flats 1 &amp; 2, or 50a &amp; 50b High Street'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_4_32\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_32\" ><label class='gfield_label gform-field-label' for='input_4_32'>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_32' id='input_4_32' type='number' step='any' min='2'  value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_4_32 gfield_description_4_32\" \/><\/div><div class='gfield_description' id='gfield_description_4_32'>We only insure all of the flats in the building \/ block<\/div><\/li><li id=\"field_4_84\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_84\" ><label class='gfield_label gform-field-label' for='input_4_84'>Overall occupancy of all the flats in the 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_84' id='input_4_84' class='medium gfield_select'  aria-describedby=\"gfield_description_4_84\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Fully occupied' >Fully occupied<\/option><option value='Part occupied \/ unoccupied' >Part occupied \/ unoccupied<\/option><option value='Unoccupied (cannot quote)' >Unoccupied (cannot quote)<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_4_84'>Choose from the drop down box below<\/div><\/li><li id=\"field_4_125\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_125\" ><label class='gfield_label gform-field-label' for='input_4_125'>Number of flats that are unoccupied?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_125' id='input_4_125' type='number' step='any' min='1' max='50' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_4_125\" \/><div class='gfield_description instruction ' id='gfield_instruction_4_125'>Please enter a number from <strong>1<\/strong> to <strong>50<\/strong>.<\/div><\/div><\/li><li id=\"field_4_85\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_85\" ><label class='gfield_label gform-field-label' for='input_4_85'>Type of occupants?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_85' id='input_4_85' class='medium gfield_select'  aria-describedby=\"gfield_description_4_85\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='freeholder \/ leaseholder occupied' >Freeholder \/ leaseholder occupied<\/option><option value='Let to professional tenants' >Let to professional tenants<\/option><option value='A mix of freeholder \/ leaseholder occupied and let to professional tenants flats' >A mix of freeholder \/ leaseholder occupied and let to professional tenants flats<\/option><option value='Part or all let to DSS claimants, students or asylum seekers (cannot quote)' >Part or all let to DSS claimants, students or asylum seekers (cannot quote)<\/option><option value='Part or all holiday lets (cannot quote)' >Part or all holiday lets (cannot quote)<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_4_85'>Choose from the drop down box below<\/div><\/li><li id=\"field_4_123\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_123\" ><label class='gfield_label gform-field-label' for='input_4_123'>Type of occupants?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_123' id='input_4_123' class='medium gfield_select'  aria-describedby=\"gfield_description_4_123\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='freeholder \/ leaseholder occupied' >Freeholder \/ leaseholder occupied<\/option><option value='Let to professional tenants' >Let to professional tenants<\/option><option value='Part or all let to DSS claimants, students or asylum seekers (cannot quote)' >Part or all let to DSS claimants, students or asylum seekers (cannot quote)<\/option><option value='Part or all holiday lets (cannot quote)' >Part or all holiday lets (cannot quote)<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_4_123'>Choose from the drop down box below<\/div><\/li><li id=\"field_4_79\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_79\" ><label class='gfield_label gform-field-label' for='input_4_79'>Is the block of flats purpose built or conversion?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_79' id='input_4_79' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Purpose built' >Purpose built<\/option><option value='Conversion' >Conversion<\/option><\/select><\/div><\/li><li id=\"field_4_103\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_103\" ><label class='gfield_label gform-field-label' for='input_4_103'>Approximate year property first 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_103' id='input_4_103' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_4_104\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_104\" ><label class='gfield_label gform-field-label' for='input_4_104'>Approximate year property purchased?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_104' id='input_4_104' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_4_29\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_29\" ><label class='gfield_label gform-field-label' for='input_4_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_4_29' class='medium gfield_select'  aria-describedby=\"gfield_description_4_29\"  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='Flint' >Flint<\/option><option value='Timber frame with brick walls' >Timber frame with brick walls<\/option><option value='Steel frame with brick or concrete walls' >Steel frame with brick or concrete walls<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_4_29'>Type to use search &#128269; <\/div><\/li><li id=\"field_4_30\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_30\" ><label class='gfield_label gform-field-label' for='input_4_30'>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_4_30' class='medium gfield_select'  aria-describedby=\"gfield_description_4_30\"  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='Concrete slab' >Concrete slab<\/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='Thatch (cannot quote)' >Thatch (cannot quote)<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_4_30'>Type to use search &#128269; <\/div><\/li><li id=\"field_4_31\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_31\" ><label class='gfield_label gform-field-label' for='input_4_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_4_31' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='0%' >0%<\/option><option value='Up to 10%' >Up to 10%<\/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 75%' >Up to 75%<\/option><option value='100% flat roof' >100% flat roof<\/option><\/select><\/div><\/li><li id=\"field_4_83\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_83\" ><label class='gfield_label gform-field-label' for='input_4_83'>Construction of the floor?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_83' id='input_4_83' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Timber' >Timber<\/option><option value='Concrete' >Concrete<\/option><\/select><\/div><\/li><li id=\"field_4_82\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_82\" ><label class='gfield_label gform-field-label' for='input_4_82'>Total number of storeys, including any basements?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_82' id='input_4_82' type='number' step='any' min='2' max='5' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_4_82\" \/><\/div><\/li><li id=\"field_4_102\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_102\" ><label class='gfield_label gform-field-label' for='input_4_102'>Is the property listed?<\/label><div class='ginput_container ginput_container_select'><select name='input_102' id='input_4_102' class='medium gfield_select'     aria-invalid=\"false\" ><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_4_40' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_4\").val(\"1\");  jQuery(\"#gform_4\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_4\").val(\"1\");  jQuery(\"#gform_4\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_4_40' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_4\").val(\"3\");  jQuery(\"#gform_4\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_4\").val(\"3\");  jQuery(\"#gform_4\").trigger(\"submit\",[true]); } ' \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_4_3_link' class='gform_save_link gform-theme-button gform-theme-button--secondary'  onclick='if(window[\"gf_submitting_4\"]){return false;}  if( !jQuery(\"#gform_4\")[0].checkValidity || jQuery(\"#gform_4\")[0].checkValidity()){window[\"gf_submitting_4\"]=true;} jQuery(\"#gform_save_4\").val(1); jQuery(\"#gform_4\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_4\"]){return false;} if( !jQuery(\"#gform_4\")[0].checkValidity || jQuery(\"#gform_4\")[0].checkValidity()){window[\"gf_submitting_4\"]=true;} jQuery(\"#gform_save_4\").val(1); jQuery(\"#gform_4\").trigger(\"submit\",[true]); }'> \ud83d\udcbe Save for later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_3' class='gform_page' data-js='page-field-id-40' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_4_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_4_72\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_72\" ><h2 class=\"gsection_title\">Enter details about the buildings cover required<\/h2><div class='gsection_description' id='gfield_description_4_72'><div align=\"right\"><a href=\"https:\/\/abi.bcis.co.uk\/checking_sum_insured\/checkingSumInsured.aspx\" target=\"_blank\"><big>&#8505;<\/big><\/a><\/div><\/div><\/li><li id=\"field_4_121\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_121\" ><label class='gfield_label gform-field-label' for='input_4_121'>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_121' id='input_4_121' type='text' step='any' min='300000'  value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_4_121 gfield_description_4_121\" \/><\/div><div class='gfield_description' id='gfield_description_4_121'>The sum insured should include all of the flats in the block<\/div><\/li><li id=\"field_4_42\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_42\" ><label class='gfield_label gform-field-label' for='input_4_42'>Accidental damage cover required for buildings?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_4_42' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Not required' >Not required<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_4_112\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_112\" ><label class='gfield_label gform-field-label' for='input_4_112'>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_112' id='input_4_112' class='medium gfield_select'    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><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_58' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_4\").val(\"2\");  jQuery(\"#gform_4\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_4\").val(\"2\");  jQuery(\"#gform_4\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_4_58' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_4\").val(\"4\");  jQuery(\"#gform_4\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_4\").val(\"4\");  jQuery(\"#gform_4\").trigger(\"submit\",[true]); } ' \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_4_4_link' class='gform_save_link gform-theme-button gform-theme-button--secondary'  onclick='if(window[\"gf_submitting_4\"]){return false;}  if( !jQuery(\"#gform_4\")[0].checkValidity || jQuery(\"#gform_4\")[0].checkValidity()){window[\"gf_submitting_4\"]=true;} jQuery(\"#gform_save_4\").val(1); jQuery(\"#gform_4\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_4\"]){return false;} if( !jQuery(\"#gform_4\")[0].checkValidity || jQuery(\"#gform_4\")[0].checkValidity()){window[\"gf_submitting_4\"]=true;} jQuery(\"#gform_save_4\").val(1); jQuery(\"#gform_4\").trigger(\"submit\",[true]); }'> \ud83d\udcbe Save for later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_4' class='gform_page' data-js='page-field-id-58' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_4_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_4_75\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_75\" ><h2 class=\"gsection_title\">About the property to be insured and the proposer(s)<\/h2><div class='gsection_description' id='gfield_description_4_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_4_120\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_120\" ><label class='gfield_label gform-field-label' for='input_4_120'>Is the property in a good state of repair and to your knowledge, free from damage or defect and will you continue to maintain it properly in the future?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_120' id='input_4_120' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No (cannot quote)' >No (cannot quote)<\/option><\/select><\/div><\/li><li id=\"field_4_113\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_113\" ><label class='gfield_label gform-field-label' for='input_4_113'>Do you plan on carrying out any renovations, conversions, extensions or other structural alterations to the property in the next 12 months?<\/label><div class='ginput_container ginput_container_select'><select name='input_113' id='input_4_113' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_4_116\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_116\" ><label class='gfield_label gform-field-label' for='input_4_116'>Is the property within 400 metres of any riverbank, sea front, lake, reservoir or quarry?<\/label><div class='ginput_container ginput_container_select'><select name='input_116' id='input_4_116' class='large 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_4_117\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_117\" ><label class='gfield_label gform-field-label' for='input_4_117'>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_117' id='input_4_117' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_4_61\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_61\" ><label class='gfield_label gform-field-label' for='input_4_61'>Has the property or the neighbouring area ever flooded or in an area at risk of flooding?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_61' id='input_4_61' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes (cannot quote)' >Yes (cannot quote)<\/option><\/select><\/div><\/li><li id=\"field_4_59\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_59\" ><label class='gfield_label gform-field-label' for='input_4_59'>Has the property ever been damaged by subsidence, ground heave or landslip, monitored for subsidence, survey reported settlement or movement, showing signs of cracking or within an area subject to subsidence?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_59' id='input_4_59' class='medium gfield_select'    aria-required=\"true\" 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_4_124\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_124\" ><label class='gfield_label gform-field-label' for='input_4_124'>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_124' id='input_4_124' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_4_108\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_108\" ><label class='gfield_label gform-field-label' for='input_4_108'>Are there any trees or shrubs over 5 metres tall within 5 metres of the 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_108' id='input_4_108' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_4_119\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_119\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Details of each tree over 5 metres tall within 5 metres of the property?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_119'><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_119_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_119_col_2' class='gfield_list_col_even' \/><col id='gfield_list_119_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_119_col_4' class='gfield_list_col_even' \/><col id='gfield_list_119_col_5' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\">Tree on your land (yes or no)?<\/th><th scope=\"col\">Species of the tree?<\/th><th scope=\"col\">Approximate height of the tree?<\/th><th scope=\"col\">Approximate distance away from the property?<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_119_cell1' data-label='Tree on your land (yes or no)?'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_119\" aria-label='Tree on your land (yes or no)?, Row 1' data-aria-label-template='Tree on your land (yes or no)?, Row {0}' type='text' name='input_119[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_119_cell2' data-label='Species of the tree?'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_119\" aria-label='Species of the tree?, Row 1' data-aria-label-template='Species of the tree?, Row {0}' type='text' name='input_119[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_119_cell3' data-label='Approximate height of the tree?'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_119\" aria-label='Approximate height of the tree?, Row 1' data-aria-label-template='Approximate height of the tree?, Row {0}' type='text' name='input_119[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_119_cell4' data-label='Approximate distance away from the property?'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_119\" aria-label='Approximate distance away from the property?, Row 1' data-aria-label-template='Approximate distance away from the property?, Row {0}' type='text' name='input_119[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 6)' onkeypress='gformAddListItem(this, 6)'><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 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><\/noscript><\/noscript><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 6)' onkeypress='gformDeleteListItem(this, 6)' 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 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><\/noscript><\/noscript><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_4_62\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_62\" ><label class='gfield_label gform-field-label' for='input_4_62'>Any unspent criminal conviction(s) or been charged (but not yet tried)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_62' id='input_4_62' class='medium gfield_select'    aria-required=\"true\" 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_4_93\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_93\" ><label class='gfield_label gform-field-label' for='input_4_93'>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_93' id='input_4_93' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_4_63\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_63\" ><label class='gfield_label gform-field-label' for='input_4_63'>Ever been declared bankrupt, insolvent or the subject of bankruptcy, insolvency or a County Court Judgement?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_63' id='input_4_63' class='medium gfield_select'    aria-required=\"true\" 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_4_94\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_94\" ><label class='gfield_label gform-field-label' for='input_4_94'>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_94' id='input_4_94' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_4_64\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_64\" ><label class='gfield_label gform-field-label' for='input_4_64'>Ever had a proposal declined, had a policy cancelled by an insurer, renewal refused or had special terms imposed?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_64' id='input_4_64' class='medium gfield_select'    aria-required=\"true\" 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_4_95\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_95\" ><label class='gfield_label gform-field-label' for='input_4_95'>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_95' id='input_4_95' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_4_65\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_65\" ><label class='gfield_label gform-field-label' for='input_4_65'>Made any claims under property 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_4_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_4_99\" class=\"gfield gfield--type-list gfield--input-type-list gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_99\" ><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_4_99'><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_99_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_99_col_2' class='gfield_list_col_even' \/><col id='gfield_list_99_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_99_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_99_cell1' data-label='Month \/ Year'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_99\" aria-label='Month \/ Year, Row 1' data-aria-label-template='Month \/ Year, Row {0}' type='text' name='input_99[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_99_cell2' data-label='Type of Claim \/ Brief Description'><input aria-invalid='false' aria-required=\"true\" 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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 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><\/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 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><\/noscript><\/noscript><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_4_110\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_4_110\" ><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_4_110'>IMPORTANT INFORMATION WHICH MUST BE READ IN FULL<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_110' id='input_4_110' class='textarea medium'      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.\nThe Consumer Insurance (Disclosure and Representations) Act 2012 sets out situations where failure by a policyholder to provide complete and accurate information requested by an insurer allows the insurer to cancel the\npolicy, sometimes back to its start date and to keep any premiums paid. The Act also places a duty on the Insurer to ensure that the questions they ask the policyholder are clear, specific and not misleading.\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 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. 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