Fillable Proposal Form for Unoccupied Property Insurance (JCT Insurance)

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Proposal Form for Unoccupied Property Insurance (JCT Insurance)

On average this form takes 11 minutes to complete

The Proposal Form for Unoccupied Property Insurance (JCT Insurance) form is 4 pages long and contains:

  • 1 signature
  • 20 check-boxes
  • 31 other fields

Country of origin: UK
File type: PDF

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Proposal Form for Unoccupied Property Insurance
Proposal Form for Unoccupied Property Insurance
Please return completed form to:-
Expert Insurance Group Horsted Square Bellbrook Business Park Uckfield Sussex TN22 1QG or Fax 01825 761479
w: www.jctinsurance.com t: 01825 745 410 e: enquiries@jctinsurance.com
Expert Insurance Group is a trading style of Affinity Select Insurance Services Limited
Authorised & regulated by the Financial Services Authority Registered in England No 3565404
IMPORTANT PLEASE READ
When completing this form, please use BLOCK CAPITALS and fill in all relevant sections, providing
additional information where necessary. Failure to complete all relevant sections of this form fully
may result in us being unable to provide terms for your site and if necessary, incomplete forms may
be returned.
This Statement of Fact is a record of the information, assumptions and material facts advised to
Insurers upon which the acceptance of the proposal and the calculation of the premium are based
and which form the basis of the contract between you and the Insurers.
You should ensure that all information provided by you is accurate and true to the best of your
belief and if any if there are any other material facts you need to disclose you should advise us
immediately. Failure to do so could invalidate your policy or result in a claim being repudiated.
A material fact is one which an insurer would regard as likely to influence their assessment and
acceptance of this insurance. If you are in any doubt whether any information is relevant this should
be declared.
General Information
Insured
Date of Birth
Occupation
Correspondence
Address
Postcode
Telephone Number
Mobile
Fax
Email
Address of property to
be insured
Postcode
What type of property is it?
Proposal Form for Unoccupied Property Insurance
Proposal Form for Unoccupied Property Insurance
Please return completed form to:-
Expert Insurance Group Horsted Square Bellbrook Business Park Uckfield Sussex TN22 1QG or Fax 01825 761479
w: www.jctinsurance.com t: 01825 745 410 e: enquiries@jctinsurance.com
Expert Insurance Group is a trading style of Affinity Select Insurance Services Limited
Authorised & regulated by the Financial Services Authority Registered in England No 3565404
How many bedrooms are in the
property?
What is the construction of the walls?
What is the construction of the roof?
What proportion of your roof is flat?
Is the property listed?
If yes please give details
Yes
No
What is the approximate year of
construction?
When did you first purchase the
property?
Is the property undergoing renovation or refurbishment?
If yes please give full details
Yes
No
Are the renovation/refurbishment being undertaken by a contractor?
If yes please give full details
Yes
No
Have you applied for planning permission?
Yes
No
If yes please give details of the council that granted permission along with the planning application
number
What is the total cost of the renovations?
When would you like the cover to start?
When did the property become
unoccupied?
Proposal Form for Unoccupied Property Insurance
Proposal Form for Unoccupied Property Insurance
Please return completed form to:-
Expert Insurance Group Horsted Square Bellbrook Business Park Uckfield Sussex TN22 1QG or Fax 01825 761479
w: www.jctinsurance.com t: 01825 745 410 e: enquiries@jctinsurance.com
Expert Insurance Group is a trading style of Affinity Select Insurance Services Limited
Authorised & regulated by the Financial Services Authority Registered in England No 3565404
What type of cover is required?
Buildings
Buildings and
Contents
What building sum insured is required?
What contents sum insured is required?
Have You:
Ever been refused property insurance or had any special terms imposed by
any insurer?
Yes
No
Ever been convicted or is there any prosecution pending for any offence
involving dishonesty of any kind?
Yes
No
Ever been declared bankrupt or been the subject of bankruptcy
proceedings or have been the subject of any voluntary or mandatory
resolution?
Yes
No
Ever been prosecuted or received notice of intended prosecution under
Health & Safety at Work Act 1974 or the Consumer Protection Act 1987?
Yes
No
Sustained loss in the last 5 years, or had a claim made against you whether
insured or otherwise, in connection with the insurance for which cover is
required?
Yes
No
If you have answered “Yes” to any of the above questions, or you are aware of any facts that might
be relevant please provide details in the Additional Information box and/or a separate sheet if
required.
Additional Information
Proposal Form for Unoccupied Property Insurance
Proposal Form for Unoccupied Property Insurance
Please return completed form to:-
Expert Insurance Group Horsted Square Bellbrook Business Park Uckfield Sussex TN22 1QG or Fax 01825 761479
w: www.jctinsurance.com t: 01825 745 410 e: enquiries@jctinsurance.com
Expert Insurance Group is a trading style of Affinity Select Insurance Services Limited
Authorised & regulated by the Financial Services Authority Registered in England No 3565404
I/we declare that to the best of my/our knowledge and belief, the information I/we have given is
correct and complete in every detail and I/we have not withheld any material fact.
I/we understand that the signing of this form does not bind us to effecting insurance but agree that
should a quotation for a new development or housing unit be accepted that this proposal and the
statements made therein shall form the basis of the contract between me/us and the Underwriter.
Signed
Name
Date
For and on behalf of
Please note documents supplied to Underwriters will be scanned and originals will not be returned
unless clearly stated.
Please return this form to: The Expert Insurance Group Horsted Square Bellbrook Business Park
Uckfield East Sussex TN22 1QG
T: 01825 745 410 F: 01825 E: enquiries@jctinsurance.com W: www.jctinsurance.com
The Expert insurance Group and JCT Insurance Expert are trading styles of Affinity Select Insurance
Services Limited. Affinity Select Insurance Services Limited is authorised and regulated by the
Financial Services Authority.
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Proposal Form for Unoccupied Property Insurance (JCT Insurance)

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Completed 10 June 2021

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