Orchard Property & Financial Services
11 Long Lane – Ickenham – Middlesex – UB10 8QU
T: +44 (0)1895 623626
F: +44 (0)1895 623929
E: info@orchardfinancialservices.com
W: www.orchardfinancialservices.com

Buildings & Contents Insurance Quote

Please complete these fields and a representative will call you as soon as possible.
Full Name	1.	2.
Date of Birth	1.	2.
Correspondance Address		Email Address
Risk Address		Daytime Tel No. Evening Tel No.
Building Type	House Detached Semi Mid Terr End Terr	Bungalow Maisonette Flat Purpose Built Converted
Tenure	Freehold Leasehold
Construction	Brick / Tile	Other
Bedrooms
Year Built		Extended? Yes No
Property to be Let?	Yes No	Tenants (Please select)
Property Listed?	Yes No	Close to Trees? Yes No
Signs of Subsidence / Movement?	Yes No
Neighbourhood Watch Scheme?	Yes No
Burglar Alarm?	Yes No	Alarm Type / Make
Smoke Alarm?	Yes No
Buildings Accidental Cover Required?	Yes No	Contents Accidental Cover Required? Yes No
Number of Years Buildings No Claims		Existing Insurer
Number of Years Contents No Claims		Existing Insurer
Claims History	Buildings Contents
Date of Claim	1.	1. Explanation
	2.	2. Explanation
Building Excess Required	£50 £100	Other
Contents Excess Required	£50 £100	Other
Valuable / High Risk item	1. (i.e. Wedding Ring)	Value
	2.	Value
	3.	Value
	4.	Value
Personal Possessions - i.e. personal effects, jewellery, watches, mobile phone up tp £15,000	Amount
Enquiry Notes
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	Any mortgage advice is given by Orchard Property & Financial Services Ltd who are authorised and regulated by the Financial Services Authority No 301573
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