Get a quote – Property Insurance

To get a quote please fill out the form and click “Submit” and one of our representatives will be in touch shortly.

Fields marked with * are mandatory fields.

First Name*

Last Name*

Home Phone Number*

Work Phone Number

Best Time To Contact Me*

Email Address*

Mailing Address (PO BOX)*

Physical Location

Principal Owner


Buildings and Contents

Sum Insured

Number of Outer Walls

Number of Inner Walls

Number of Windows

Number of Roofs

Number of Floors

Number of Storeys

Are the buildings and or out buildings within 20ft of another building

How is it constructed?

For what purpose is it used?

Is any business/ profession/ trade carried on in the dwelling or in any portion of the premises of which the dwelling forms a part?

How old is the building

How big is the building (Sq ft)

Year built / renovated

Details of burglary protection

Are the Buildings in a good state of repair and will they be so maintained?

What is the occupancy type?

Premises Occupied by

Number of Tenants, lodgers, boarders or paying guests:

For how many days (consecutive) will the dwelling be left without an inhabitant in any one year?

General Contents - Value

Electronic Equipment (Television sets, DVD players, Stereos, Internal Satellite) Value:
(Break-down required)

Computer Equipment Value:
(Break-down will be required)

Jewellery Value:
(Valuation will be required)

Coverage Type

Has any Company or Insurer, in respect of any of the contingencies:
Declined to insure youRequired special terms to insure youCancelled/refused to renew your insuranceNone of the above

If YES, please give full particulars:

Have you any other policies in force covering any of the contingencies to be insured against?

If YES, please give full particulars:

Have you sustained any losses during the past 3 years?

If YES, please give full particulars: