Royal Horticultural Society Quotation Request

Please complete this quotation carefully. It is a record of the statements made and information given by you to obtain a quote and constitutes the basis on which your contract of insurance will be based. All material facts must be disclosed. A material fact is one which is likely to influence an insurer in the assessment and acceptance of the application. Material facts must be disclosed in relation to yourself and all persons who are to be insured. If you are in any doubt as to whether a fact is material then it should always be disclosed.

Failure to disclose all material information or any change in the information advised (i.e. information likely to influence the assessment of the risk) could invalidate the insurance quotation. We reserve the right to decline any risk or to change the premium and terms quoted.

Title

First Name

Surname

Date of Birth

/ /

Address

Postcode

Telephone

E-mail address

Occupation

Expiry date of current insurance

/ /

Current insurer

Policy number

RHS membership number

Have you or any member of your household:

Had any previous insurance declined?	Yes No
Been convicted of or charged with any criminal offence?	Yes No
Been declared bankrupt?	Yes No

How did you hear about us?

Details about your home

What year was your home built?

Number of bedrooms

Type of home

Home Security:

Are the main exit doors fitted with 5-lever mortice deadlocks?	Yes No
Are key-operated window locks fitted?	Yes No
Do you have a NACOSS approved intruder alarm fitted?	Yes No
Are you a member of a Neighbourhood Watch scheme?	Yes No
Is your home regularly left unattended other than during normal working hours?	Yes No

What is the construction of the walls?

What is the construction of the roof?

What is the occupancy of the property?

Is the property::

In a good state of repair and will be so maintained?	Yes No
Used for business use in any way?	Yes No
Free from any exposure to storm or flooding?	Yes No
Free from signs of damage by subsidence?	Yes No
Free from signs of damage by landslip?	Yes No
Free from signs of damage by ground heave?	Yes No
Near a river or quarry?	Yes No
A listed property?	Yes No

Buildings

The sum insured must represent the cost of rebuilding to the same specification (including garages, outbuildings, etc) plus approximately 15% to cover demolition costs and architects and surveyors fees. THIS MAY BE DIFFERENT TO THE MARKET VALUE OF THE PROPERTY.

Sum insured (min £35,000)

Accidental damage is included automatically for your main residence.

Interested party

Account number (if applicable)

The sum insured on Contents must represent the full cost of replacing all the property insured without allowance for wear, tear and depreciation other than for clothing, household linen and pedal cycles.

Sum insured (min £15,000)

Do you require Accidental Damage cover?

Yes No

Do paying guests stay with you?

Yes No

Valuables:
Valuables compromise stamp, coin or medal collections, curios, pictures, works of art, articles of gold, silver, jewellery or fur. The single article limit for valuables is 5% of the contents sum insured or £2,000 whichever is greater. List below the items which exceed this amount. (NB. valuations are required for jewellery, fur or paintings over £2,500)

Your valuables list

Personal Belongings

Unspecified personal possessions sum insured
(min £2,000), Single article limit £1,500

Specified items and values

Pedal Cycles Maximum Sum Insured per cycle

Garden Cover

Covers damage to flower beds, lawns, plants, shrubs or trees, ornaments, statues or garden furniture in the garden within the boundaries of your home. Overall sum insured £10,000, inner limits apply to individual items, please refer to the policy wording for full details of cover.

Family Legal Protection

Covers Family Legal Expenses including costs and expenses for you and your immediate family. Maximum payment £50,000 for any claim or series of claims. Please refer to the Policy Wording for full details of cover.

Claims History

Date	Claim Type	Cost	Section

Additional Information

RHS Home and Garden Insurance is a trading name of Alan Boswell Insurance Brokers Limited.
Alan Boswell Insurance Brokers Limited is authorised and regulated by the Financial Services Authority.
Alan Boswell Insurance Brokers Limited is registered in England No. 02591252.