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Independent Insurance Advice for over 25 years

Personal Insurance

High Net Worth

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 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
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 any safes at the premises including make, model and age:
Details of the Cover Required/Sums Insured  
Main residence
Tenants Improvements
General Contents
(excluding categories below but including clothing, baggage and personal possessions)
Fine Art  
Antique furniture
Porcelain/Brittle items
Gold, silver and plated items
Other fine art
Jewellery & Furs  
Unspecified jewellery under £5,000
Total of specified jewellery in excess of £5,000
Jewellery in a bank
Worldwide Travel  
Family Cover
Winter Sports Option
Do you have a recent full valuation?
Name of valuer
Valuation dated
Current policy excess
Existing premium
Existing insurer
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.