LPOC Select Qualifying Form

"*" indicates required fields

To confirm your eligibility for the Select range of insurance products please complete our short form below. If you are unable to obtain an online quotation then we are pleased to advise that our Bespoke listed home policies may be more suitable and the team will be in touch once we have received your information.

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POLICY HOLDER DETAILS

Policy Holder Name:

Title First Name Last Name

Email Address

Address (Incl. Postcode):*

Address City Postcode

Phone Number:*

Buildings Rebuild Value (Including Outbuildings) Please put £0 if unsure.*

In order to ensure that you have the correct cover, you need to specify an accurate rebuild sum for your property. This is different to the property’s market value and must reflect the full rebuild cost to reinstate the property as it was using appropriate materials and methods as instructed by your conservation officer. If you are unsure of the rebuild cost for your property, please speak to one of the team on 01795 844939 for assistance in arranging for a professionally qualified surveyor to advise on a suitable figure.

Do you require contents insurance?*

Yes

When do you need cover by?*

Is any part of the roof thatch?*

How did you hear about us?*

We are pleased to advise that our Bespoke listed home policies may be more suitable. Please complete the remaining questions and the team will be in touch.

Further Details

Date of Birth:*

Occupation:

Employer:

Current Insurer:

Current Premium:

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I am happy to be contacted with relevant information from LPOC via (please tick)

Post

Phone

Remember, to receive the free LPOC newsletter The Listed Property Insider, which includes helpful information on the issues facing listed property owners, please opt-in to receive emails.

Are you the owner of the property?*

Yes

Is it a Joint Policy?*

Yes

Occupation:

Employer:

POLICY HOLDER DETAILS

Further Details

PROPERTY DETAILS

THATCHED PROPERTY DETAILS

HOW IS THE PROPERTY OCCUPIED?

SECURITY & FIRE PROTECTION INFORMATION

COVER REQUIRED

ADDITIONAL INFORMATION

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