Yellow Bolts - Household Insurance Proposal Form
PLEASE ANSWER ALL QUESTIONS HONESTLY, ACCURATELY AND TO THE BEST OF YOUR KNOWLEDGE. The answers you provide will form the basis of your insurance quotation. If you are unsure about what is relevant, please let us know as it may influence the insurer’s decision to accept the risk or could impact the terms of cover.

If you fail to disclose or misrepresent any information, this could invalidate the policy and mean that claims may not be paid or not paid in full. Any deliberate or reckless non-disclosure may mean that the insurer can void the policy and retain the premium. This applies when you take out a policy, during the term of the policy and when you renew.
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1. Proposer Details
Inception date required *
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Title *
Full name *
Date of birth *
Contact number *
Email address *
Are you a UK resident? *
If not, country of residence
Correspondence address *
Occupation / profession
Business or employer name (if applicable)
2. Main Residence Details
Risk address (main residence) *
Property type *
Approximate year built
Number of bedrooms
Number of storeys (excluding basement)
Does the property have a basement? *
Is the property listed? *
If yes, what grade?
Approximate rebuild cost *
Approximate market value
3. Construction & Specialist Features
Wall construction *
If non-standard, please specify
Roof construction *
Percentage of flat roof
If flat roof, what material is it made of?
Does the property have any specialist features? *
If yes, please provide details
e.g. listed features, bespoke finishes, wine cellar, gym, cinema room, outbuildings, gates, stables, tennis court, pool house
4. Occupancy & Use
Is the property *
Will the property be unoccupied for more than 30 consecutive days? *
Will the property be unoccupied for more than 90 consecutive days? *
Any business use at the property? *
If yes, please provide details
Are there domestic staff employed at the property? *
If yes, please provide details
e.g. housekeeper, nanny, gardener, chauffeur, estate manager
5. Security
Are all final exit doors fitted with appropriate locks? *
Are all accessible windows fitted with key-operated locks? *
Is there an intruder alarm? *
If yes, please provide alarm details
e.g. audible, monitored, central station, maintenance contract
Is there CCTV? *
Are there electric gates or controlled access? *
Is there a safe or vault? *
If yes, please provide details of how it is fitted and its grade
6. Valuables & Collections
Are there any individual items valued over £10,000? *
If yes, please provide details
Do you require cover for jewellery, watches, art, antiques, collectibles or fine wine? *
If yes, please provide full details
Are professional valuations available for high-value items? *
Do you require worldwide all-risks cover for valuables? *
7. Additional Buildings & Land
Are there any outbuildings, annexes or other structures? *
If yes, please provide details
Is there a swimming pool, hot tub, tennis court or similar amenity? *
If yes, please provide details
Are there gates, boundary walls or extensive landscaping to be included? *
If yes, please provide details
8. Property Condition & Risk
Is the property in a good state of repair? *
Are any renovations, refurbishments or building works in progress or planned? *
If yes, please provide details
Has the property ever suffered from subsidence? *
Has the property ever suffered from landslip? *
9. Environmental Risk
Has the property ever flooded? *
Is the property within 400 metres of a watercourse? *
Are there trees or shrubs within 7 metres of the property that are over 3 metres high?
Clear selection
Is there a willow tree within 40 metres of the property? *
10. Cover Requirements
Buildings sum insured *
Contents sum insured *
Do you require accidental damage cover?
Clear selection
Do you require personal possessions cover? *
Do you require home emergency cover? *
Do you require legal expenses cover?
Clear selection
Do you require worldwide all-risks cover? *
11. Other Residences
Do you own any other properties requiring cover? *
If yes, please provide details
Include address, use, and approximate sums insured if known
12. Claims, Insurance, Convictions & Financial History
Any claims in the past 5 years? *
If yes, please provide details
Current insurer
Current premium
Has any insurance held by you or any resident family member ever been declined, cancelled, voided or had special terms imposed?
Clear selection
If yes, please provide full details

Have you or any resident family member ever been convicted of any criminal offence? If yes please provide details
Have you or any resident family member ever been declared bankrupt, entered into an Individual Voluntary Arrangement (IVA), had a County Court Judgment (CCJ), or been subject to any similar financial arrangement? *
If yes, please provide details including date, status (e.g. satisfied/discharged) and any relevant context
Any additional information that may be relevant
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