Home Insurance

Please complete the following enquiry form for a Home Insurance Quotation.

Eircode of your dwelling *

Amount of buildings cover required *

Amount of home contents cover required *

Amount of cover for personal effects & Jewellery by accidental means

Is the premises occupied by you and members of your household as your main house? *

Are the premises occupied solely for private residential purposes? *

Is the premises of standard construction, i.e. built of brick, stone, concrete & roofed 100% with slate or tile *

If no, please give details

Other Details

D.O.B *

Occupation *

Are at least two smoke detectors fitted in the property? *

Is the property in a Neighbourhood watch or Community Alert area?

Monitored burglar alarm (to IS199) fitted to the property? *

Year of construction *

Number of bedrooms *

Number of bathrooms *

How is your dwelling heated? *

How long have you lived at this property? *

First time buyer? *

If no – Name of existing insurer:

If no – Renewal date:

Who are your private car insurers? *

Please give details of any claims you have made in the last 5 years on this or any other property *

Contact Details

Name *

Telephone *

E-mail

Other Contact Details

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