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Property Insurance Quote Request

"*" indicates required fields

Thank you for visiting our quotation form. Any field dispalying an asterisk is a required field.
Property Type*
How would you like to request a quotation?
One of our specialists will call you back during office hours.
One of our specialists will review the detail and come back to you via email or phone.
One of our team will call you back (Weekdays between 9 am and 5 pm)

Client Details

Client Date of Birth
Partner/Joint Date of Birth
Renewal Date

Risk Details

Address of property to be insured + Correspondence address.
Is the property: -
Is the property used for any business purposes other than clerical?
Does the property have a history of subsidence heave or landslip or are there any signs of subsidence?
Any trees/vegetation more than 5metres high within 10 metres of the any part of the property?
Does the property have a history of flooding or is it located within 400m of a watercourse or the sea?
Is the property due to undergo, or undergoing renovations or works during policy period?
Does the property have minimum physical security? e.g. five lever deadlocks and key operated window locks
Have you ever had insurance cancelled, renewal declined or any additional terms imposed?
Have you, whether insured or not , made any claims or incurred any losses or damage during the last five years?
Claim 1
Date
Claim 2
Date
Claim 3
Date
Claim 4
Date
Claim 5
Date
Is the property protected by an intruder alarm?
If yes, is the alarm maintained by a NACOSS/NSI/SSAIB approved firm?
Do you have a safe?
If yes, what type of signalling

Buildings Cover

Voluntary excess (if required)
(Compulsory excess automatically applies to buildings cover)
Is accidental damage cover required?

Contents Cover (A)

Voluntary excess (if required)
(Compulsory excess automatically applies to buildings cover)
Is accidental damage cover required?

Valuables Cover (B)

(Specify valuables over £5,000)
Unspecified total
Specified total
Jewellery *****see notes
Jewellery in the bank
Guns
Wine collections
Collections (please specify e.g. stamps, coins, books)
Voluntary excess (if required)
(Compulsory excess automatically applies to buildings cover)

Additional Information / Material facts / Criminal Convictions / Bankruptcy

Please list below any additional information required or that you feel may help underwriters in assessing the risk

Consent

We will only use the information submitted in this form to make contact with you regarding your enquiry. Your details will be stored securely and will never be passed to third parties outside of the quoting for and arrangement of your insurance or communications from Evergreen. Please tick the box to confirm you are happy with this.*
Please check this box to confirm you are happy to receive the Evergreen e-newsletter.
Please check this box to confirm you are happy to receive e-communications from our charity friends.
Please tick this box if you are happy for our friends and partners at Eden Associates to contact you regarding your mortgage or remortgage requirements. By using Eden Associates, you’ll also be helping support Brent Lodge Wildlife Hospital.
MM slash DD slash YYYY
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Evergreen Insurance Services is a trading name of Surry Independent Advisors Limited, who is authorised and regulated by the Financial Conduct Authority. FCA Number: 228148. Registered in England and Wales. Registered Number: 02947585. Registered Office: Elmwood House Ghyll Royd, Guiseley, Leeds, England, LS20 9LT ｜Designed by RJ Web Design
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