Quantum Mortgage Brokers / General Insurance / Enquiry

Enquiry Form

The details on this form will enable us to introduce you to a mortgage consultant who will assess your case before providing you with a personalised quote. Please remember there is no obligation to buy but we ask you only complete this enquiry if you are serious about receiving mortgage or remortgage quotations as you will be contacted via telephone by a mortgage specialist.

Title

First Name

Surname

Date of Birth

(dd/mm/yyyy)

Sex

male female

	Address	Risk Address if different

Line 1
Line 2
Town
County
Post Code
Country

Type of cover

Cover Required For

Level of Cover

Type Of Property

Construction

Year Built

Number of bedrooms

Rebuild Cost

Contents Cover Required

(if applicable)

Have you held this type of insurance before? Yes No

Number of years No Claims Discount

Details of any claims in the last 5 years

I have:

...been refused insurance or had special terms imposed (yes)

...convictions or police cautions other than for motoring offences (yes)

...prosecutions pending (yes)

The Property:

...has key operated locks to all ground floor windows (yes)

...has 5 lever mortice deadlocks on all exit doors (yes)

...will be permanantly occupied by me or my family (yes)

...will not be left unoccupied for any reason for more than 30 days (yes)

...is used for business purposes (yes)

...is listed (yes)

Please enter any information that will be helpful when we contact you

I have read, understood and agree to the Data Protection Declaration: Yes No

I agree to further contact as described in Our Future Relationship: Yes No



	Introduction
		Why do you need insurance?
	What to Insure
		Buildings Insurance
		Contents Insurance
	Hints and Tips
		Home Security
		Security Alarms
		Subsidence
		Flooding
		Fire
	Forms and files
		Request a Quote
		Fire Safety In the Home (pdf)
		Contents Calculator (pdf)
		Flood Resilient Homes (pdf)
		Clearing Up After A Flood (pdf)