AIF Insurance Facilities
telephone: 020 8923 7558
fax: 020 8281 7770
email: info@alfa-insurance.co.uk
Get a quote

To receive a quote, please fill in the form below and then click on "Submit"

Items suffixed with a * are compulsary and must be provided

Alternatively, you can download a printable version of this form in either Adobe PDF or Microsoft Word format and fax or post it to us.


Personal Information - Introducer
Title* Email*
Forename* Telephone*
Surname* Mobile
  Fax
Correspondence Address
Address Line 1* Town/City*
Address Line 2* Region/County*
  Postcode*
Risk Address
Forename of Insured* Surname of Insured*
Address Line 1* Town/City*
Address Line 2* Region/County*
  Postcode*
 
Risk Details
What is the property occupied as ?* If a Hotel or Guesthouse, is accommodation for DSS offered ?
Building Sum Insured*
(this should represent rebuilding as new cost)		  
Approx year of construction*  
Is the property listed ?* If yes, which grade ?
Is the building built of brick or stone and roofed with tile or slate or other non- combustible material ?*  
Is the entire building to be insured ?*  
Is the property occupied other than as a private domestic residence ?*  
What type of tenant is the property let to ?* For example; Working, Housing Benefit, Students, Post-grad Students, To Local Authority, Social Housing, Housing Association, Asylum Seekers.
Is the property occupied or vacant ?* If unoccupied, how long unoccupied and is the property on the market to rent ?
Is there any structural work to be carried out ?*  
Has the property/area ever suffered from subsidence, landslip or heave ?*  
Has the property/area ever suffered from flooding ?*  
Is the property in a good state of repair ?* If no, please indicate
Is the property professionally
managed?*		  
Has any insurance claim been made by the insured in the last five years ?* If Yes, please detail
Has insurance ever been refused or special terms imposed ?*  
Has the insured any convictions or is any prosecution pending for any criminal offence other than driving offences ?*  
Has the Insured ever been declared bankrupt or insolvent or had any county court judgements registered against them ?*  
Date of inception ?*  
Submitted by*  
Position  
 
   
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