email
Address
Confirm email Address
Title
Mr.
Mrs.
Miss.
Ms.
Dr.
Other
First
Name
Surname
Tel.
Number - Day
Tel.
Number - Evening
Where
Did You See Us Advertised
Existing
Customer (Any Product)
YES
NO
Property
to be Insured:
Is the property a Livery Yard
YES
NO
House
Number/Name
Street
Town
County
Post
Code
Country
UK
Is there a clearly defined Perimeter around the property
YES
NO
Correspondence
Address if different:
House
Number/Name
Street
Town
County
Post
Code
Country
Is
Buildings Cover Required
YES
NO
Is Public Liability Cover Required
YES
NO
Number
of Stables
Standard building sum insured (Brick, Mortar,Tile or Slate construction)
£
If a flat, house or bungalow is to be covered, please give number of bedrooms
Non-Standard building sum insured (Timber, Corrugated Iron & Out Buildings including Barns & Field Shelters etc.)
£
General Contents & Machinery (TV, Radio etc.)
£
Jumps & Equipment
£
Saddles, Tack, Tools, Rugs etc
£
Hay, Straw & Feed
£
Business Interruption (12 Months)
£
Money & Assault
£
Quad Bikes or similar
£
Please
give details of any claims you have had in connection with this business.
Include Date & Cost
Present
Insurer
Renewal
Date
Renewal
Premium
£
Declaration:
I declare that the information I have given above is true and complete.
I have not withheld any material facts (see IMPORTANT
NOTES .) I agree that this proposal shall form the basis of
the Contract between me and Shearwater Insurance.
Shearwater
Insurance Services Ltd
Registered Office: 2 Bath Place, London, EC2A 3JJ. Registered in the UK Company
No: 02701633