Home Insurance Quotation Form

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If by a friend, family or referrer please state their name and number.

“Registered with the ICO, all your personal information is protected under the Data Protection Act 1998”

Personal Info

YesNo



YesNo


YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

Your Insurance History

YesNo

The Property

Is built with brick walls?
Is more than 400 meters away from water
Has a roof made of slate or tile
Is not for sale
Has never shown signs of heave, landslip or subsidence
Is your main residence
Has not had underpinning or structural support
Is not currently undergoing building work
Has never suffered from flooding
Has no significant cracks on the external wall

YesNo


Clearco Insurance