The Insurance Shop
Home Insurance Quotation
Proposers Name:
  
Risk Address:
   
Date of Birth:
  
Contact Number:
  
Contact Mobile:
  
Own Residence:
  Yes No
Rented Residence:
  Yes No
If Rented, to whom and how many people (family, students etc):
  
Years house was built (approx):
  
If over 100 years when last rewired, re-rooked, re-plumbed   
How long living there:
  
Standard Construction (Brick/Slate Roof):
  Yes No
If No please advise details and percentage unstandard:
  
Is it a listed building:
  Yes No
House type:
 
Number of Bedrooms:
  
Is your house alarmed:
  Yes No
If yes, is the Alarm to EN50131/NSAI Standard:
  Yes No
If yes, is the Alarm linked to a central station (e.g. Eircom Phonewatch):
  Yes No
Is there a minimum of two smoke alarms:
  Yes No
Is the house occupied during the day:
  Yes No
Are external doors fitted with five lever mortice deadlocks:
  Yes No
Are windows fitted with key-opened security locks:
  Yes No
Present Car Insurer:
  
Sums Insured
Buildings:
€
Contents:
€
Unspecified Valuables:
€
Specified Valuables (Total):
€
Pedal Cycles:
€
   
Claims in last five years:
  
Home Office/Surgery:
 
Paying Guests:
  

 

Phone 01- 8366663

Fax 01 - 8555010

Email info@tis.ie

The Insurance Shop
84 North Strand Rd
Fairview
Dublin 3

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