Welcome to the Chancery Wright Insurance Brokers Ltd

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PROPERTY INSURANCE

DETAILS OF PROPERTY

Location:

Construction type 1) Roof

2) Wall

Sum insured: 1) Buildings

2) Contents

Cover required - Please tick as appropriate:

Fire Contents All risks

Financial interest, State either bank or self

Security in place:

OTHER POLICIES

Any other policy insuring this property? Yes No

If so state insurer and policy number

INSURANCE HISTORY

Has any insurer -:

Declined to insure you?

Yes No

Required special terms to insure you ?

Yes No

Cancelled or declined to renew your insurance?

Yes No

Increased premium at renewal?

Yes No

CLAIMS HISTORY

Have you claimed in the past?

Yes No

If so please give details

DECLARATION

I do hereby declare that the above answers are true and I have not withheld any material information regarding this proposal.

SIGNATURE __________________

DATE: _____/_____/_____

Click to download Data request form – Property Insurance
	Data request form –Property Insurance