High Net Worth Buildings & Contents Enquiry Form

Please complete the form below and click 'submit':

Name
Address
Postcode
How should we contact you?	Please select Email Telephone Post
Telephone Number
Email Address
Occupation
Date of Birth	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023
Have you had any claims or losses in the last 5 years?	Please select No Yes
If Yes, please give details, including the date, brief information of each incident and the cost of claim paid.
Type of property	Please select Detached House Semi Detached House Terraced House Bungalow Semi Detached Bungalow Purpose Built Flat Converted Flat Other
Year Built
Number of Bedrooms	Please select 1 2 3 4 5 6 7 8 9 10+
Is the home...?
Built of brick, stone or concrete and roofed with slates, tiles, metal, asphalt or concrete	Please select No Yes
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	Please select No Yes
Free from previous underpinning or any remedial action of any type in connection with subsidence, ground heave, landslip or coastal or river erosion	Please select No Yes
Regularly occupied during the day	Please select No Yes
Regularly occupied during the night and not left unoccupied for more than 30 consecutive days	Please select No Yes
Occupied solely by the proposer and members of their family for private residential purposes	Please select No Yes
Fitted with 5 Lever Mortice Deadlocks to all external doors	Please select No Yes
Fitted with key operated window and patio door locks to all ground floor windows and patio doors	Please select No Yes
Fitted with a NACOSS or SSAIB approved Burglar Alarm System, with a maintenance agreement	Please select None Audible Only Digicom RedCare
Details of any safes at the premises including make, model and age:
Details of the Cover Required/Sums Insured
Buildings
Main residence
Outbuildings
Tenants Improvements
General Contents
(excluding categories below but including clothing, baggage and personal possessions)
Fine Art
Pictures/Books
Antique furniture
Porcelain/Brittle items
Gold, silver and plated items
Guns
Wine
Coins/Medals
Other fine art
Jewellery & Furs
Unspecified jewellery under £5,000
Total of specified jewellery in excess of £5,000
Jewellery in a bank
Furs
Worldwide Travel
Family Cover	Please select Required Not Required
Winter Sports Option	Please select Required Not Required
Do you have a recent full valuation?	Please select Yes No
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.