callbruce
0845 226 0909

LET Insurance Submission Form

NB If you are not registered with Call Bruce CLICK HERE for our introducers form

Broker's Name
BrokerContactNo
If joint cover is required, please complete both sections.

General Questions

Proposer

Partner

 

Title: (Mr/Mrs/Miss/Ms/Dr etc.)

 
First Name(s):
 

Surname:

 

Gender:

 
Marital Status:





 

Date of Birth:

 
Occupation:  

Clients Address:




RISK Address

Clients Postal Code:

RISK Postal Code:
       

Contact Telephone No’s.:

Day:

Mobile:

 

Cover Required :

Property Type:

Detached Semi Terraced Bungalow Flat
No. of Bedrooms:
Buildings only:
Sum Insured


Standard Excess only?



If no, specify higher value

Buildings & Contents:

Sums Insured


Standard Excess only?



If no, specify higher value

Please give full details of Tenant (i.e. Tenant, Professional)
Age of Property:
Mortgaged by Whom:
How long is the let for?
Number of unrelated people in the property?
About the Property:  
Are there any signs of damage due to subsidence, shift, landslip or heave?


Is the property located in an area known for flooding?


Are there any trees near your property?


Does anyone other than only you and your family living in the property?


Is the property normally left unoccupied for more than 5 working days per week?


Is the property left empty for more than 30 consecutive days?


Does the Property have a flat roof?


Do you have locks fitted to all your doors and windows?


Do you have any special requirements for the policy


If you have answered yes to any of these questions, please provide full details. Please also provide us with details of the locks in the property.
Are you a member of a neighbour hood watch scheme?


Are you a first time buyer?


State construction details (i.e. brick/tile, stone/slate etc.)of property
About You  
Have you ever been refused insurance or had any special terms or restrictions imposed at this or any other home?


Have you suffered any losses or claims in the last 5 years on either section of your policy?


Have you ever been convicted or have any prosecutions pending (other than motor)


Have you ever been made bankrupt or have any hearings pending?


If you have answered yes to any of these questions, please provide full details
Your Current Insurance (please complete where appropriate)
What NCD do you have on Buildings? What NCD do you have on Contents?
Who is your current Insurer? What start date do you require?

All material facts must be disclosed. Failure to do so may invalidate the policy. Should you require further information on a particular policy please contact callbruce immediately on 0845 226 0909. We reserve the right to contact your previous insurer to confirm your insurance history. The premium indication given from this submission form is valid for 30 days.

Members of B.I.B.A

Authorised and regulated by the Financial Services Authority
A UNITAS Broker