Household quick quote

1. About you

Name(s) of insured *

Full postal address *

Postcode *

Email *

Contact telephone *

Fax

Do you carry on a business from your home?

YesNo

If yes, please give details

Please confirm that public liability insurance for this business is already insured elsewhere

YesNo

2. Your house

Household buildings (rebuilding cost including outbuildings)

Is your house built of stone, brick or concrete and roofed in slate or tile?

YesNo

How many bedrooms in the house?

Unspecified general contents

Unspecified personal effects (Worldwide cover)

Specified jewellery

Antiques and paintings

Sporting equipment

Computer equipment

Laptops

Money/credit cards

YesNo

Freezer contents

YesNo

Bicycles

YesNo

Garden machinery and outdoor effects

Other

If other, please describe

Have you made any claims on your household insurance during the last three years?

YesNo

Insurance products

Pets & animal trades
Farms & countryside
Equestrian
Commercial
Household

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Terms and conditions

Cliverton, 15-17 Norwich Road, Fakenham, Norfolk NR21 8AU
Tel: 01328 857921 Fax: 01328 857959 Email: info@cliverton.co.uk
Cliverton is a trading name of Lycett, Browne-Swinburne & Douglass Ltd. which is authorised and regulated by the Financial Services Authority (FSA No. 310623).