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Independent Insurance Advice for over 25 years

Personal Insurance

High Net Worth

Buildings & Contents Enquiry Form

Please complete the form below and click 'submit':

How should we contact you?
Telephone Number
Email Address
Date of Birth
Have you had any claims or losses in the
last 5 years?

If Yes, please give details, including the date, brief information of each incident and the cost of claim paid.

Type of property
Year Built
Number of Bedrooms
Is the property rented?
Is the home...?  
Built of brick, stone or concrete and roofed with slates, tiles, metal, asphalt or concrete
In good repair, free from damage or defect of any kind and in an area normally free from flooding, free from and in an area normally free from subsidence, ground heave, landslip or costal or river erosion
Free from previous underpinning or any remedial action of any type in connection with subsidence, ground heave, landslip or coastal or river erosion
Regularly occupied during the day
Regularly occupied during the night and not left unoccupied for more than 30 consecutive days
Occupied solely by the proposer and members of their family for private residential purposes
If not, please give details:
Fitted with 5 Lever Mortice Deadlocks to
all external doors
Fitted with key operated window and patio
door locks to all ground floor windows
and patio doors
Fitted with a NACOSS or SSAIB approved
Burglar Alarm System, with a
maintenance agreement
Details of the Cover Required/Sums Insured
Estimated Rebuilding Cost
General Contents  
Sum Insured
Personal Possessions (Away from the home)
Unspecified Personal Possessions & Jewellery
(Single Item Limit £1,000)
Items over £1,000:

Additional Options (Check box if required)  
Credit Cards  
Freezer Contents  
Legal Expenses  
Please provide any other information that might affect the underwriter's assessment
of this risk.


The details you have provided will be used by Chubb Insurance Brokers to send you the information you have requested. We may wish to contact you by post, email or telephone. By providing your contact details or when completing an online quotation you are consenting to be contacted about that quotation. We may also wish to use your details to let you know about other products and services offered by Chubb Insurance Brokers Ltd, full details available on request, and carefully selected third parties. By providing your contact details you are consenting to be contacted for such marketing purposes.