{"id":6612,"date":"2014-05-31T07:56:49","date_gmt":"2014-05-31T06:56:49","guid":{"rendered":"https:\/\/www.emberjd.com\/?p=6612"},"modified":"2020-07-27T13:49:38","modified_gmt":"2020-07-27T12:49:38","slug":"freeholders-quote","status":"publish","type":"post","link":"https:\/\/www.emberjd.com\/what-we-insure\/freeholders-quote\/","title":{"rendered":"Freeholders Quote"},"content":{"rendered":"<p><script type=\"text\/javascript\">\/\/ <![CDATA[\nfunction MM_validateForm() { \/\/v4.0\n  if (document.getElementById){\n    var i,p,q,nm,test,num,min,max,errors='',args=MM_validateForm.arguments;\n    for (i=0; i<(args.length-2); i+=3) { test=args[i+2]; val=document.getElementById(args[i]);\n      if (val) { nm=val.name; if ((val=val.value)!=\"\") {\n        if (test.indexOf('isEmail')!=-1) { p=val.indexOf('@');\n          if (p<1 || p==(val.length-1)) errors+='- '+nm+' must contain an e-mail address.\\n';\n        } else if (test!='R') { num = parseFloat(val);\n          if (isNaN(val)) errors+='- '+nm+' must contain a number.\\n';\n          if (test.indexOf('inRange') != -1) { p=test.indexOf(':');\n            min=test.substring(8,p); max=test.substring(p+1);\n            if (num<min || max<num) errors+='- '+nm+' must contain a number between '+min+' and '+max+'.\\n';       } } } else if (test.charAt(0) == 'R') errors += '- '+nm+' is required.\\n'; }     } if (errors) alert('The following error(s) occurred:\\n'+errors);     document.MM_returnValue = (errors == ''); } }\n\/\/ ]]><\/script><\/p>\n<p><\/head><\/p>\n<h3>Fill in the form below for a Freeholders Residential Flats Insurance quote<\/h3>\n<p><a href=\"javascript:;\" onClick=\"window.open('important-information','myWin','scrollbars=yes,width=590,height=330');\">Important please read<\/a>, click on each tab below and carefully answer the questions<\/p>\n<form id=\"home\" class=\"unoccupied\" action=\"https:\/\/www.emberjd.com\/sendformfreeholders.php\" method=\"post\">\n<div id=\"TabbedPanels1\" class=\"TabbedPanels\">\n<ul class=\"TabbedPanelsTabGroup\">\n<li class=\"TabbedPanelsTab\">Start<\/li>\n<li class=\"TabbedPanelsTab\">About You<\/li>\n<li class=\"TabbedPanelsTab\">Contact<\/li>\n<li class=\"TabbedPanelsTab\">The Property<\/li>\n<li class=\"TabbedPanelsTab\">Cover<\/li>\n<li class=\"TabbedPanelsTab\">Final Details<\/li>\n<li class=\"TabbedPanelsTab\">Submit for Quote<\/li>\n<\/ul>\n<div class=\"TabbedPanelsContentGroup\">\n<div class=\"TabbedPanelsContent\">\n<h3>General details<\/h3>\n<table class=\"formtable\" border=\"0\" cellspacing=\"0\" cellpadding=\"2\" width=\"651\">\n<tbody>\n<tr>\n<td width=\"60%\" align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Renewal date \/ Cover date?<\/p>\n<\/td>\n<td><span id=\"sprytextfield1\"><\/p>\n<p><input id=\"coverdate\" class=\"textinput\" name=\"coverdate\" type=\"text\" \/> <strong>*<\/strong> <span class=\"textfieldRequiredMsg\">A value is required.<\/span><span class=\"textfieldMinCharsMsg\">Looks too short for a date &#8211; e.g. 30\/01\/2009<\/span><span class=\"textfieldMaxCharsMsg\">Looks too long for a date e.g. 30\/01\/2009<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Renewal premium?<\/p>\n<\/td>\n<td><input id=\"renewalpremium\" class=\"textinput\" name=\"renewalpremium\" type=\"text\" value=\"\u00a3\" \/><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Where did you hear about us?<\/p>\n<\/td>\n<td><span id=\"sprytextfield2\"><\/p>\n<p><input id=\"Source\" class=\"textinput\" name=\"Source\" type=\"text\" \/> <strong>*<\/strong> <span class=\"textfieldRequiredMsg\">We need to know this.<\/span><span class=\"textfieldMinCharsMsg\">We need a little bit more than that&#8221;<\/span><span class=\"textfieldMaxCharsMsg\">That&#8217;s slightly too much text<\/span><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"mandatory\"><strong>Questions marked * are mandatory, click <span style=\"text-decoration: underline;\">About You<\/span> tab above to continue<\/strong><\/p>\n<\/div>\n<div class=\"TabbedPanelsContent\">\n<h3>Enter your details as the freeholder, residents association or management company<\/h3>\n<table class=\"formtable\" border=\"0\" cellspacing=\"0\" cellpadding=\"2\" width=\"651\">\n<tbody>\n<tr>\n<td width=\"60%\" align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Title?<\/p>\n<\/td>\n<td colspan=\"3\"><select id=\"title\" class=\"textselectbox\" name=\"title\"><option selected=\"selected\">Mr<\/option><option>Mrs<\/option><option>Miss<\/option><option>Ms<\/option><option>Dr<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">First name?<\/p>\n<\/td>\n<td colspan=\"3\"><span id=\"sprytextfield3\"><\/p>\n<p><input id=\"Firstname\" name=\"Firstname\" type=\"text\" \/> <strong>*<\/strong> <span class=\"textfieldRequiredMsg\">We need to know this detail.<\/span><span class=\"textfieldMinCharsMsg\">Your name is longer than this!<\/span><span class=\"textfieldMaxCharsMsg\">That&#8217;s too long for a name!<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Surname?<\/p>\n<\/td>\n<td colspan=\"3\"><span id=\"sprytextfield4\"><\/p>\n<p><input id=\"Surname\" name=\"Surname\" type=\"text\" \/> <strong>*<\/strong> <span class=\"textfieldRequiredMsg\">We need to know this detail.<\/span><span class=\"textfieldMinCharsMsg\">Your name is longer than this!<\/span><span class=\"textfieldMaxCharsMsg\">That&#8217;s too long for a name!<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Let us know your interest in the property?<\/p>\n<\/td>\n<td colspan=\"2\"><span id=\"spryselect2\"><br \/>\n\t\t<select name=\"the_proposer_is_a_\" id=\"the_proposer_is_a_\"><option>Freeholder<\/option><option>Residents association<\/option><option>Management company<\/option><option>Leaseholder (cannot quote)<\/option><option selected=\"selected\">Please choose<\/option><\/select><br \/>\n\t\t<span class=\"selectInvalidMsg\">Please select a valid item.<\/span><\/span><\/td>\n<td><strong>*<\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"middle\">\n<p class=\"formlabel\">IF insured in residents assoc or company name:<\/p>\n<\/td>\n<td colspan=\"3\" align=\"left\" valign=\"middle\"><input type=\"text\" name=\"name_of_company_residents_assoc_\" id=\"name_of_company_residents_assoc_\" value=\"Name of residents association or company\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"mandatory\"><strong>Questions marked * are mandatory, click <span style=\"text-decoration: underline;\">Contact<\/span> tab above to continue<\/strong><\/p>\n<\/div>\n<div class=\"TabbedPanelsContent\">\n<h3>Please enter your contact details,<a href=\"javascript:;\" onClick=\"window.open('contact-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\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 10px; --smush-placeholder-aspect-ratio: 10\/15;\" \/><noscript><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\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 10px; --smush-placeholder-aspect-ratio: 10\/15;\" \/><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\" \/><\/noscript><\/noscript><\/a> we will reply to your quote request by email<\/h3>\n<table class=\"formtable\" border=\"0\" cellspacing=\"0\" cellpadding=\"2\" width=\"651\">\n<tbody>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Telephone number?<\/p>\n<\/td>\n<td><span id=\"sprytextfield6\"><\/p>\n<p><input id=\"contactphonenumber\" class=\"textinput\" name=\"contactphonenumber\" type=\"text\" \/><strong>*<\/strong><span class=\"textfieldRequiredMsg\">A value is required.<\/span><span class=\"textfieldMinCharsMsg\">Minimum number of characters not met.<\/span><span class=\"textfieldMaxCharsMsg\">Exceeded maximum number of characters.<\/span><\/p>\n<p><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Email address?<\/p>\n<\/td>\n<td><span id=\"sprytextfield5\"><\/p>\n<p><input id=\"contactemailaddress\" class=\"textinput\" name=\"contactemailaddress\" type=\"text\" \/><strong>*<\/strong><span class=\"textfieldRequiredMsg\">A value is required.<\/span><span class=\"textfieldInvalidFormatMsg\">Invalid format.<\/span><\/p>\n<p><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"mandatory\"><strong>Questions marked * are mandatory, click <span style=\"text-decoration: underline;\">The Property<\/span> tab above to continue<\/strong><\/p>\n<\/div>\n<div class=\"TabbedPanelsContent\">\n<h3>Please enter details about the property to be insured<\/h3>\n<table class=\"formtable\" border=\"0\" cellspacing=\"0\" cellpadding=\"2\" width=\"651\">\n<tbody>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Are the flats?<\/p>\n<\/td>\n<td colspan=\"2\"><select id=\"typeofflat\" name=\"typeofflat\"><option>Conversion <\/option><option>Purpose built <\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td width=\"60%\" align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Property name \/ number?<\/p>\n<\/td>\n<td colspan=\"2\"><span id=\"sprytextfield7\"><\/p>\n<p><input id=\"Housenumber\" class=\"textinput\" name=\"Housenumber\" type=\"text\" \/> <strong>*<\/strong> <span class=\"textfieldRequiredMsg\">A value is required.<\/span><span class=\"textfieldMinCharsMsg\">Minimum number of characters not met.<\/span><span class=\"textfieldMaxCharsMsg\">Exceeded maximum number of characters.<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Postcode?<\/p>\n<\/td>\n<td colspan=\"2\"><span id=\"sprytextfield8\"><\/p>\n<p><input id=\"postcode\" class=\"textinput\" name=\"postcode\" type=\"text\" \/> <strong>*<\/strong> <span class=\"textfieldRequiredMsg\">A value is required.<\/span><span class=\"textfieldMinCharsMsg\">Minimum number of characters not met.<\/span><span class=\"textfieldMaxCharsMsg\">Exceeded maximum number of characters.<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Approximate year property built?<\/p>\n<\/td>\n<td colspan=\"2\"><span id=\"sprytextfield9\"><\/p>\n<p><input id=\"Yrbuilt2\" class=\"textinput\" name=\"Yrbuilt\" type=\"text\" \/> <strong>*<\/strong> <span class=\"textfieldRequiredMsg\">A value is required.<\/span><span class=\"textfieldInvalidFormatMsg\">Invalid format.<\/span><span class=\"textfieldMinCharsMsg\">Minimum number of characters not met.<\/span><span class=\"textfieldMaxCharsMsg\">Exceeded maximum number of characters.<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Approximate year property purchased?<\/p>\n<\/td>\n<td colspan=\"2\"><span id=\"sprytextfield10\"><\/p>\n<p><input id=\"Yrpurchased2\" class=\"textinput\" name=\"Yrpurchased\" type=\"text\" \/> <strong>*<\/strong> <span class=\"textfieldRequiredMsg\">A value is required.<\/span><span class=\"textfieldInvalidFormatMsg\">Invalid format.<\/span><span class=\"textfieldMinCharsMsg\">Minimum number of characters not met.<\/span><span class=\"textfieldMaxCharsMsg\">Exceeded maximum number of characters.<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Is the property a listed building?<\/p>\n<\/td>\n<td colspan=\"2\"><select id=\"\" name=\"IsThePropertyListed\"><option selected=\"selected\">No<\/option><option>Yes<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Construction of the external walls?<\/p>\n<\/td>\n<td><select id=\"constructiontype\" name=\"constructiontype\"><option selected=\"selected\"value=\"Brick construction\">Brick<\/option><option value=\"Render over brick\">Render over brick<\/option><option value=\"Stone\/Flint\">Stone\/Flint<\/option><option value=\"Concrete construction\">Concrete<\/option><option value=\"Timber frame with brick walls\">Timber frame with brick walls<\/option><option value=\"Timber frame with plaster panels\">Timber frame with plaster panels<\/option><option value=\"Timber\">Timber<\/option><option value=\"Wattle and daub\">Wattle and daub<\/option><option value=\"Cob\">Cob<\/option><option value=\"Prefabricated (no quote)\">Prefabricated (cannot quote)<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td class=\"formlabel\">\n<p class=\"formlabel\">Construction of the roof?<\/td>\n<td colspan=\"2\"><select id=\"roofconstruction\" name=\"roofconstruction\"><option selected=\"selected\">Tile or slate<\/option><option>Concrete<\/option><option>Felt over timber<\/option><option>Thatch (cannot quote)<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Approximate percentage of any flat roof?<\/p>\n<\/td>\n<td><select id=\"constructiontype\" name=\"percentage of flat roof\"><option selected=\"selected\"value=\"0%\">0%<\/option><option value=\"5%\">Up to 5%<\/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=\"100%\">100%<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td>\n<p class=\"formlabel\">Total number of flats?<\/p>\n<\/td>\n<td colspan=\"2\"><span id=\"sprytextfield11\"><\/p>\n<p><input id=\"numberofflats\" name=\"numberofflats\" type=\"text\" \/><strong>*<\/strong><br \/>\n<span class=\"textfieldRequiredMsg\">A value is required.<\/span><span class=\"textfieldMinCharsMsg\">Minimum number of characters not met.<\/span><span class=\"textfieldMaxCharsMsg\">Exceeded maximum number of characters.<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td>\n<p class=\"formlabel\">Total number of storeys?<\/p>\n<\/td>\n<td colspan=\"2\"><span id=\"sprytextfield14\"><br \/>\n\t<input id=\"numberofstoreys\" name=\"numberofstoreys\" type=\"text\" \/><strong>*<\/strong>\t<span class=\"textfieldRequiredMsg\">A value is required.<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td>\n<p class=\"formlabel\">Is the floor?<\/p>\n<\/td>\n<td colspan=\"2\"><select id=\"floortype\" name=\"floortype\"><option>Timber<\/option><option>Concrete<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Is the property?<\/p>\n<\/td>\n<td colspan=\"2\"><select id=\"FlatOccupation\" name=\"FlatOccupation\"><option>Fully occupied<\/option><option>Part occupied \/ unoccupied (cannot quote)<\/option><option>Unoccupied (cannot quote)<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Are the flats?<\/p>\n<\/td>\n<td colspan=\"2\"><select id=\"WhoOccupiesTheFlats\" name=\"WhoOccupiesThe Flats\"><option>Leaseholder occupied<\/option><option>Let<\/option><option>Leaseholder occupied \/ Let<\/option><option>Part or all holiday lets (cannot quote)<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">If any of the flats are let out, how many?<\/p>\n<\/td>\n<td colspan=\"2\"><input type=\"text\" name=\"how_many_flats_are_let\" id=\"how_many_flats_are_let\" \/><\/td>\n<\/tr>\n<tr>\n<td class=\"formlabel\">\n<p class=\"formlabel\">If any flats are let, select the type of tenants?<\/p>\n<\/td>\n<td colspan=\"2\"><select id=\"TypeOfTenants\" name=\"TypeOfTenants\"><option selected=\"selected\">None let out<\/option><option>Professional tenants<\/option><option>Student tenants<\/option><option>DSS claimants (cannot quote)<\/option><option>Asylum seekers (cannot quote)<\/option><\/select><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"mandatory\"><strong>Questions marked * are mandatory, click <span style=\"text-decoration: underline;\">Cover<\/span> tab above to continue<\/strong><\/p>\n<\/div>\n<div class=\"TabbedPanelsContent\">\n<h3>Please enter details about the buildings cover required<\/h3>\n<table class=\"formtable\" border=\"0\" cellspacing=\"0\" cellpadding=\"2\" width=\"651\">\n<tbody>\n<tr>\n<td width=\"60%\" align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Rebuilding cost of the property?<\/p>\n<\/td>\n<td colspan=\"2\"><span id=\"sprytextfield12\"><\/p>\n<p><input id=\"Rebuild\" class=\"textinput\" name=\"Rebuild\" type=\"text\" \/> <span class=\"textfieldRequiredMsg\">A value is required.<\/span><strong>* <\/strong><span class=\"textfieldMinCharsMsg\">Minimum number of characters not met.<\/span><span class=\"textfieldMaxCharsMsg\">Exceeded maximum number of characters.<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">Accidental damage cover required for buildings?<\/p>\n<\/td>\n<td><span id=\"spryselect1\"><\/p>\n<p><select id=\"AccDamCoverRequired\" name=\"AccDamCoverRequired\"><option>Yes<\/option><option>No<\/option><option selected=\"selected\">Please choose<\/option><\/select><span class=\"selectInvalidMsg\">Please select a valid item.<\/span><\/p>\n<p><\/span><\/td>\n<td><strong>*<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"mandatory\"><strong>Questions marked * are mandatory, click <span style=\"text-decoration: underline;\">Final Details<\/span> tab above to continue<\/strong><\/p>\n<\/div>\n<div class=\"TabbedPanelsContent\">\n<h3>Has the policyholder(s) and the property to be insured<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\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 10px; --smush-placeholder-aspect-ratio: 10\/15;\" \/><noscript><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\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 10px; --smush-placeholder-aspect-ratio: 10\/15;\" \/><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\" \/><\/noscript><\/noscript><\/a><\/h3>\n<table class=\"formtable\" border=\"0\" cellspacing=\"0\" cellpadding=\"2\" width=\"651\">\n<tbody>\n<tr>\n<td width=\"70%\" align=\"left\" valign=\"top\">\n<p class=\"formlabel\"><span style=\"font-size: small;\">Any unspent criminal conviction(s) or pending prosecution(s)?<\/span><\/p>\n<\/td>\n<td width=\"9%\"><select id=\"Convictions\" class=\"textselectbox\" name=\"Convictions\"><option value=\"Yes\">Yes (give details in box below)<\/option><option selected=\"selected\" value=\"No\">No<\/option><\/select><\/td>\n<td align=\"left\"><strong>*<\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\"><span style=\"font-size: small;\">Ever been declared bankrupt or the subject of bankruptcy proceedings?<\/span><\/p>\n<\/td>\n<td><select id=\"Bankrupt or bankruptcy proceedings\" class=\"textselectbox\" name=\"Bankrupt or bankruptcy proceedings\"><option value=\"Yes\">Yes (give details in box below)<\/option><option selected=\"selected\" value=\"No\">No<\/option><\/select><\/td>\n<td align=\"left\"><strong>*<\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\"><span style=\"font-size: small;\">Ever had a proposal declined, had a policy cancelled by an insurer, renewal refused or had special terms imposed?<\/span><\/p>\n<\/td>\n<td><select id=\"Insurance refused declined cancelled or special terms\" class=\"textselectbox\" name=\"Insurance refused declined cancelled or special terms\"><option value=\"Yes\">Yes (give details in box below)<\/option><option selected=\"selected\" value=\"No\">No<\/option><\/select><\/td>\n<td align=\"left\"><strong>*<\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\"><span style=\"font-size: small;\">Has the property or the neighbouring area ever flooded or in an area at risk of flooding?<\/span><\/p>\n<\/td>\n<td><select id=\"Has the property or the neighbouring area ever flooded or in an area at risk of flooding\" class=\"textselectbox\" name=\"Has the property or the neighbouring area ever flooded or in an area at risk of flooding\"><option value=\"Yes (cannot quote)\">Yes (regret cannot offer quote)<\/option><option selected=\"selected\" value=\"No\">No<\/option><\/select><\/td>\n<td align=\"left\"><strong>*<\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\"><span style=\"font-size: small;\">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?<\/span><\/p>\n<\/td>\n<td><select id=\"damage from subsidence, heave landslip cracks or had movement\" class=\"textselectbox\" name=\"damage from subsidence, heave or landslip cracks or had movement\"><option value=\"Yes (cannot quote)\">Yes (regret cannot offer quote)<\/option><option selected=\"selected\" value=\"No\">No<\/option><\/select><\/td>\n<td><strong>*<\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\"><span style=\"font-size: small;\">Are there any trees or shrubs over 10 metres tall within 10 metres of the property?<\/p>\n<p><\/span><\/td>\n<td><select id=\"trees or shrubs over 10 metres within 10 metres of property\" class=\"textselectbox\" name=\"trees or shrubs over 10 metres within 10 metres of property\"><option value=\"Yes (cannot quote)\">Yes (regret cannot offer quote)<\/option><option selected=\"selected\" value=\"No\">No<\/option><\/select><\/td>\n<td align=\"left\"><strong>*<\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\"><span style=\"font-size: small;\">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?<\/span><\/p>\n<\/td>\n<td><select id=\"claims in the last 5 years\" class=\"textselectbox\" name=\"claims in the last 5 years\"><option value=\"Yes\">Yes (give details in box below)<\/option><option selected=\"selected\" value=\"No\">No<\/option><\/select><\/td>\n<td align=\"left\"><strong>*<\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"top\">\n<p class=\"formlabel\">\n<p class=\"formlabel\">If you have answered <strong>Yes<\/strong> to any of the questions above, please give details here.<br \/>\nFor each claim in the last 5 years we need to know: [Month\/Year], [Type of Claim] and [Cost].<\/p>\n<\/td>\n<td colspan=\"2\"><textarea id=\"textarea\" cols=\"4\" rows=\"3\" name=\"textarea2\"><\/textarea><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"mandatory\"><strong>Questions marked * are mandatory, click <span style=\"text-decoration: underline;\">Submit for Quote<\/span> tab above to continue<\/strong><\/p>\n<\/div>\n<div class=\"TabbedPanelsContent\">\n<h3>Click submit, we will then contact you by email as soon as we have obtained a quote<\/h3>\n<table class=\"formtable\" border=\"0\" cellspacing=\"0\" cellpadding=\"2\" width=\"651\">\n<tbody>\n<tr>\n<td width=\"338\" align=\"center\"><input id=\"button\" name=\"button\" type=\"submit\" value=\"SUBMIT\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"mandatory\"><strong>If you remain on this page after clicking submit, please re-check the quote form by clicking on each tab. 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