Please fill in the form below Personal Details   Email: Date: (mm/dd/yy) Tel No.: Fax No.: Name:* Date of birth: (mm/dd/yy) Occupation: Nature of employer's business: Current insurer: Renewal premium: Renewal date: (mm/dd/yy) Current excess Have you ever had insurance cancelled, refused, or any terms imposed? Yes No Risk Detail   Address of property to be insured:       Postcode: Policy excess required £100   £250  £500   Yes No year of construction:  Listed: If yes give details below     Standard Construction? (Brick, stone, slate and tile) Regularly occupied? Signs or history of subsidence, heave or landslip Business use? History of flooding or or within 400m of a watercourse? Undergoing/Due to undergo renovations of works?       Security     Yes No 5 lever Mortice Deadlock on external doors? If no, please provide details below     Key operated window locks? Alarm with NSI/SSAIB maintenance contract? Bell/siren only Digital Communicator Dualcom Redcare GSM Redcar Other     Safe?       Manufacturer: Model: Cash rating: Buildings Cover   Main Building sum insured: Outbuildings Sum insured: Contents Cover   General Contents: (Excluding the following) Personal possessions: (Excl. jewellery) Unspecified jewellery: Specified jewellery (single article limit £5000 or more) Gold silver plate: Jewellery in the bank: Paintings, fine arts and antiques: (Do not include any item over £1500 - specify bellow) Guns: Collections: Others: Claims history in last 5 years?   Any additional information   Morgan Insurance Consultants is a trading style of Headley Insurance Services Ltd which is authorised and regulated by the Financial Services Authority and is entered on the FSA register (www.fsa.gov.uk) under reference 306701. Headley Insurance services. Registered Office William Curtis House Lenten Street Alton GU34 1HH . Registered in England.