Claim Questionnaire

Please complete the questions below to the best of your knowledge.

Providing us with this information enables us to speed up the handling of your claim, as your insurer or their loss adjuster will request this in order to process a claim. Please rest assured that this information will be dealt with in the strictest confidence, and will only be exchanged with your insurer for the purposes of the administration of this claim.

If you are unsure about any of the questions, please contact our office on 01628 788 600.

Please complete the questions below to the best of your knowledge.

If you are unsure about any of the questions, please contact our office on 01628 788 600.

Title

First Name

Last Name

Address of affected property

Postcode

When was the property built?

How long have you lived at your current property?

Who permanently resides at the property?

Please provide names, dates of birth and occupations, as well as their relation to you (if any). If the property is tenanted, please also specify this.

How many bedrooms does the property have?

Please provide the name of any insurer who has provided buildings cover to you at the property over the past three years. Please also provide the dates covered by each insurer.

Have you made any previous claims on your buildings insurance policy?

If these were within the past 5 years, please provide the following details; date of claim, reason for claim and the claim’s worth.

Are you aware if any rain / surface water connects to the foul system?

Yes

Don't know

When was the property’s existing drainage system installed?

How frequently do you have the system emptied?

What is the name of the company that empties the tank for you?

Please provide the dates of the last 3 times the tank has been emptied prior to noticing a problem:

Have you had to have any additional empties since having problems with the system? If so, how many times?

Approximately what date did you first notice the problem?

Only answer if you have a Sewage Treatment Plant: How frequently is the system serviced?

Do you have a mortgage against the property? If so, who is the mortgage provider?