Ultimart Home Insurance Quote

To allow us to provide you with a quote as quickly as possible, please complete the form below and we will be in touch.

The form is set over a number of pages, so please have all your details to hand before progressing. Do not navigate away from the page while completing the form as your progress will be lost.

Alternatively you can download and complete our PDF version and email to enquiries@ultimart.co.uk

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First Name(s) *

Surname *

Tel *

Email *

D.O.B *

Occupation *

Risk Address including Post Code *

Current Insurer *

Current Premium *

Renewal Date *

General Information

Date property built

Type of property e.g Detached house

Is the property listed?

Yes

No

Grade

Wall construction:

Brick

Stone

Other

Wall Construction Details:

Roof construction:

Tile

Slate

Other

Roof construction Details:

Is the property:

In a good state of repair?

Yes

No

State of repair note:

Occupied as your main home?

Yes

No

Occupiers main home note:

Occupied solely by you/family?

Yes

No

Occupancy note:

Regularly left unattended during the day (other than normal working hours)?

Yes

No

Unattended note:

Ever left unoccupied for more than 60 consecutive days or unfurnished for more than 30 consecutive days?

Yes

No

Unoccupied note:

Used for any trade or business?

Yes

No

Trade or business note:

Is any renovation/construction work ongoing or planned in the next 12 months?
a) where the cost of works will exceed £75k
b) where the contract requires insurance in joint names with the contractor

Yes

No

Renovation/construction note:

Details of any financial interest

Has the property or its grounds ever flooded?

Yes

No

Flood note:

Is it located within a potential flood risk area?

Yes

No

Flood risk area note:

Has the property ever suffered subsidence, heave or landslip damage?

Yes

No

Subsidence, heave or landslip damage note:

Are you aware of any such damage to neighbouring properties?

Yes

No

Neighbouring damage note:

Any visible cracking to the walls of the property internally/externally?

Yes

No

Cracked walls note:

Are there any trees over 3 metres tall within 10 metres of the property?

Yes

No

Trees note:

End Section

Been refused insurance or had special terms applied?

Yes

No

Refused insurance note:

Been convicted of or charged with a criminal offence or received a Police caution?

Yes

No

Offence note:

Been declared bankrupt or been the subject of bankruptcy proceedings, been served with any county court judgements (CCJs) or other judgements in relation to debt or entered into an Individual Voluntary Arrangement (IVA)?

Yes

No

Note:

Details of any claims and/or losses within the last 5 years (whether claims made or not)

Level of excess required:

£250

£500

£1,000

£2,500

Minimum excess is £500 on buildings and contents.

External doors: 5LMDs or Multi-point locking?

Yes

No

External doors note:

Patio doors: Multi-point locking or top & bottom locks?

Yes

No

Patio doors note:

Accessible External windows: Key operated window locks?

Yes

No

External windows note:

Fully functional alarm system:

Yes

No

Alarm details

Other alarm details:

NSI Gold/NACOSS/SSAIB Approved?

Yes

No

Note:

Subject to a maintenance contract?

Yes

No

Contract note:

Safe:

Yes

No

Make/model

Wall, floor or freestanding

Cash rating

Anchored?

Yes

No

Other security information (Porterage, CCTV, etc)

Fire Protections:

Smoke detectors

Mains

Battery

Monitored

Fire blankets

Yes

No

Fire extinguishers

Yes

No

End Section

Contents:

General contents (including personal effects (£)

Wine collection (£)

Saddles and tack (£)

Outdoor items (e.g. garden furniture, statuary or urns) (£)

Tractor mowers, tractors or quad bikes (£)

Art:

End Section

Do you currently have your art insured with Ultimart?

Yes

No

If no, what is the value of your collection? (£)

Antiques:

Household gold, platinum, pewter and silverware (£)

Paintings, drawings, maps, prints, photographs, books, tapestries and rugs (£)

Clocks, barometers, statues, sculptures, stamps, coins, medals, collectables and other fine art (£)

China, glassware and porcelain (£)

Antique and designer furniture (£)

Specified Items:
Please provide details on a separate list if necessary

Jewellery and Watches:

Normally worn on a day to day basis (£)

Normally kept in a safe at the home (£)

Kept in a bank vault or safety deposit (£)

Specified Items:
Please provide details on a separate list if necessary

Buildings:

Main building (£)

Domestic outbuildings (£)

Additional Comments

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