Fillable Self-Build and Liability Insurance (JCT Insurance)

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Self-Build and Liability Insurance (JCT Insurance)

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The Self-Build and Liability Insurance (JCT Insurance) form is 3 pages long and contains:

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

Country of origin: UK
File type: PDF

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Self-Build and Liability Insurance
Proposal Form for Self-Build Projects
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
Please complete in CAPITAL LETTERS using black ink and tick boxes as appropriate. Please complete all questions where applicable
and provide full details where applicable, particularly for questions with GREY boxes.
1
Employer/Property Owner Details
Name
Occupation
Date of Birth
Correspondence Address
Telephone Number
Email Address
Address of Property/Site undergoing Works
2
Generic Proposer Risk Information and Declarations – have any of the above proposers for this insurance:
Made an insurance claim on property insurance (whether paid or not) in the last 5 years?
Ever been convicted of any criminal offence, other than a motoring offence?
Ever been declared bankrupt or subject to bankruptcy proceedings?
Ever had property insurance declined, cancelled or any special terms imposed for any reason?
3
Details of the Property/Site to be Insured
Please provide an overview of the Works being undertaken
At what stage are the Works currently? E.g. full planning, building regs submitted, foundations stage, weathertight etc.
What are the estimated dates for:
Start
Completion
Self-Build and Liability Insurance
Proposal Form for Self-Build Projects
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
If the Works have already started, please advise how much has been spent to date and what Works have already taken place
4
If the Works are a NEW BUILD please answer the following questions
What is the rebuild/reinstatement cost upon completion?
£
What style best describes the Property upon completion? E.g.
detached/semi-detached house, bungalow etc.
What will the construction of the walls and the roof be?
What type of heating will the Property have?
Will the Property be retained or sold/rented after completion?
5
If the Works are an EXTENSION, CONVERSION OR RENOVATION please answer the following questions
Type of Property E.g. detached house, terrace, bungalow etc.
Rebuild/Reinstatement cost of the Property
£
Construction of the existing walls and the roof
Approximate year of build
Is the Property listed?
What is the total cost of the Works? This should include VAT
(if applicable) and professional fees.
£
Construction of the new walls and the roof
6
General Questions
Is the Property/Site in an area with a history of subsidence?
Is the Property/Site in an area with a history of flooding?
Do you or a family member live within 25 metres of the site?
Will there be any piling or underpinning work involved in your project?
Will there be any excavation work over 2 metres in depth, shoring, propping or dewatering involved in
your project?
Do you require cover for owned and hired in plant, including site huts and caravans?
Do you require cover for employee’s tools and personal effects?
Does anyone else have a financial interest in your property/project?
If you have answered “Yes” to any of the above questions with a GREY box, please advise details below
Self-Build and Liability Insurance
Proposal Form for Self-Build Projects
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
Please Note: A text based signature is not accepted by insurers
Do you require a quotation for Non-Negligence Insurance?
A separate form will need completing and returning to us in order to obtain a full quotation.
IMPORTANT
Please read the following carefully before you sign and date the Declaration.
If you have answered “Yes” to any of the questions on this enquiry form with a GREY BOX, please supply any Additional Information
unable to be included in the space provided below.
The questions on this proposal form and any other details we specifically request relate to facts which we consider material to
underwriting this insurance. However, because no list of questions can be exhaustive please consider whether there is any other
material information which is known to you which could influence our assessment and acceptance of the risk. Failure to disclose all
material facts whether or not the subject of a specific question may invalidate your insurance.
We recommend that you should keep a record, including copies of letters and this Proposal Form, of all information supplied to us for
the purpose of entering into this insurance.
DECLARATION
Before signing the Declaration please check your answers carefully, particularly if this Proposal Form is not completed in your own hand.
I/We declare that to the best of my/our knowledge and belief the answers given are true and complete.
I/We agree that if any answers have been completed by any other person, such person shall for that purpose be regarded as my/our
agent and acting on my/our behalf.
I/We agree that the information provided on this Proposal Form and any information supplied by me/us shall be incorporated in and
form part of the insurance contract.
Signature of Proposer(s)
Date of signing
Title of Signatory:
Additional Information:
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Self-Build and Liability Insurance (JCT Insurance)

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Completed 10 June 2021

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