Smart Water Email    
Smart Water Product ID    
Contact Name    
Address    
Postcode    
Home Phone    
Daytime Phone    
Insured D.O.B    
Insured Ocupation    
Spouse D.O.B    
Spouse Ocupation    
Is your House  
Number of Bedrooms    
Year House Built    
 
Yes No
Is the property Brick, stone concrete and roofed with slates tiles or concrete
Is the property in good state of repair
Is the property free from any signs of damaged caused by landslip subsidence or heave
Has the property ever suffered from any damage caused by landslip subsidence or heave
Is the property in a flood free area
is the property a listed building
Is the property used for any business or professional purposes
Has your family had any insurance declined, cancelled or declare void and household insurance
Does anyone in your household smoke
Buildings Cover
Value of home    
Acidentail Damage Cover   Yes No  
Contents Cover
Replacement cost Inc. Valubles    
 
Yes No

Is any one valuable within the home worth more than £2000

Do you require Accidental Damage

Do you require family legal protection

Are you a member of a police approved neighbourhood watch scheme

Is your home protected by a smoke alarm
Is your home protected by a NACOSS approved alarm system under an annual maintenance contract
Is your home occupied during the day
Are all external doors fitted with 5 lever locks
Are all accessible windows and patio doors fitted with key operated locks
Personal Belongings
Belongings Value    
Money & Credit Cards   Yes No  
Sports Equiptment Value    
Pedal Cycles   Yes No