Please Fill in the following       Name Address Date of Birth Occupation Tel ( HOME) Tel ( WORK) E-mail Address to be Insured * if different from above Please confirm where you heard of Britton Insurance   SELECT autotrader www.insurancewide.com golden_pages other_search_engine Setanta Sport Radio donedeal.ie Kildare Driving Academy Driving School Sum Insured       BUILDINGS CONTENTS Bank or Mortgage Society to be noted (if appropriate)       Company Name Address       Is the property detached/semi-detached/terraced/other?       Answer Here       Please answer ALL of the following questions. Is the Property: Only occupied by yourself and your family? YES NO Regularly occupied at night? YES NO Used solely for residential purposes? YES NO Roofed with slates or tiles throughout? YES NO Of concrete construction and roofed with slates or tiles throughout YES NO Are any of the roofs flat or of non standard construction, if so what percentage is non standard If you have answered 'NO' to any of the above questions please give detail       Answer Here         How many years have you had house insurance in your own name without any claims?       Answer Here       Have you had any claims in respect of any household policy in the previous six years whether a payment made or not? YES NO Please give details of any claims during the past 5 years and state date, brief description of claim and settlement cost       Answer Here       Please give description of any items you wish to insure and value of same:       Answer Here       ADDITIONAL INFORMATION FOR HOUSE INSURANCE Alarm System Installed YES NO Is it installed by NSAI approved installer? YES NO Is it installed by NSAI approved installer and connected to a central monitoring station? YES NO Are the window locks key operated YES NO Are there 5 lever locks installed on all external doors? YES NO Two smoke alarms installed YES NO Neighbourhood Watch YES NO Number of Bedrooms If let to tenants, how many? Year Built Renewal Date If you hold a current Motor Insurance Policy please confirm the name of the Company this is with       Answer Here         To allow us to stop spaming of online forms we require you to enter the following text into the verification field below.