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First Name:
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Last Name:
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Postcode:
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Address Line 1:
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City/ Town:
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Telephone:
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Occupation:
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Details Of The Property

Property to Insure Postcode:
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Property to Insure Line 1:
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Property to Insure Line 2:
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Property to Insure City/ Town:
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Property Type
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Construction Of Walls:
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Construction Of Roof:
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Is The Building Listed:
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Works Description:
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Contract Value / How Much Spending On Works:
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Year Built:
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Occupied During Work:
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Work Commences (dd/mm/yy):
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Is It Weatherproof:
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Is It Secure:
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Any History Of Subsidence Or Landslip At This Property Or The Immediate Vicinity:
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Previously Had Any Flooding At The Premises Or Nearby:
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Building Sum Insured:
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Contents Sum Insured:
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Any Previous Claims:
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Have You Or Any Persons To Be Insured Ever Been Bankrupt, Had Any CCJ's Or Been Convicted Of Any Criminal Convictions:
Please select whether you or any persons to be insured ever been bankrupt, had any CCJ's or been convicted of any criminal convictions