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HR Solutions & Employee Benefits
Oct 23, 2019
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News
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Marine
Motor
Private Clients
Professional Indemnity
Property
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Enquiry Form
Enquiry Form
Name
First
Last
Last
Email
Subject
Message
Submit
×
CYBER INSURANCE QUOTATION FORM
Your Business
Business Name
*
Address Line 1
*
Address Line 2
Country
*
Post Code
*
The gross income of the business in the last completed financial year (or estimate for the current year if you are a new business):
*
General Business Description
*
Number of records processed or stored annually:
Business Sector
*
Accountancy/Tax
Architects
Broadcasting
Charity, club or association
Construction
Consultancy services
Engineering
Estate/property agency
Hospitality
Legal services
Manufacturing
Marketing, advertising, publishing
Other professional services
Recruitment agency/consultancy
Retailers
Technology and telecommunications
Transportation and warehousing
CONTACT DETAILS
Phone Number
*
Email Address
*
Are you an existing Sovereign Insurance Services client?
Yes
No
YOUR COVER
Option 1
Limit of Indemnity
*
£100,000
£250,000
£500,000
£1,000,000
£1,500,000
£2,000,000
Excess
*
£2,500
£5,000
Option 2
Limit of Indemnity
£100,000
£250,000
£500,000
£1,000,000
£1,500,000
£2,000,000
Excess
£2,500
£5,000
Option 3
Limit of Indemnity
£100,000
£250,000
£500,000
£1,000,000
£1,500,000
£2,000,000
Excess
£2,500
£5,000
Submit
×
HOME INSURANCE QUOTATION FORM
HOME INSURANCE QUOTATION FORM
Please fill the form accurately for better assistance
PROPOSER DETAILS
Prefix
*
First Name
*
Middle Name
Last Name
*
Date of Birth
*
Marital Status
Single
Married
Common Law
Divorced
Separated
Partnered
Widowed
N/A
Occupation
REQUIRED IF IN JOINT NAMES
Prefix
First Name
Middle Name
Last Name
Date
Marital Status
Single
Married
Common Law
Divorced
Separated
Partnered
Widowed
N/A
Occupation
PROPERTY DETAILS
Address of Property to be Insured - Street Address
*
Street Address Line 2
Street Address Line 3
State/Province
Postal/Zip
Country
*
Property Use
*
Main Residence
Holiday Home
Let
Other
Property Use
If you have selected 'Let', do you require Consequential Loss of Rent Cover?
Yes
No
If 'Yes' provide your annual rental income:
Ownership
*
Property Owner
Landlord
Tenant
Year of Build
Roof Type
Asphalt
Concrete
Metal
Slate
Thatch
Tile
Timber
Other
Roof Type
Wall Type
Brick
Concrete
Stone
Other
Wall Type
ADDITIONAL DETAILS
Cover Required
*
Building Only
Contents Only
Building and Contents
Currency
*
GBP (£)
Euro (€)
USD ($)
Building Sum Insured
Tenants Improvements
Fixtures and Fittings
Contents Sum Insured
All Risks
SECURITY AND CLAIMS HISTORY
Is this property fitted with a direct alarm?
*
Yes
No
Will the property be unoccupied for more than 30 consecutive days?
*
Yes
No
Has the property ever experienced or shown signs of subsidence, flooding, landslip or heave?
*
Yes
No
Has the insured or anybody residing with the insured...
Had any loss or damage during the last 5 years?
*
Yes
No
Had insurance declined, refused or special terms imposed?
*
Yes
No
Been convicted or charged with any offence? (Other than driving offences)
*
Yes
No
If you answered ‘Yes’ to any of the last 5 questions, please provide details:
Are you an existing Sovereign Insurance Services client?
*
Yes
No
How did you hear about Sovereign Insurance Services?:
*
Preferred contact method:
Phone
Email
Both
Phone Number
Email Address
Submit
×
MOTOR INSURANCE QUOTATION FORM
MOTOR INSURANCE QUOTATION FORM
Please fill the form accurately for better assistance
NAME
Prefix
*
First Name
*
Middle Name
Last Name
*
PERSONAL DETAILS
Date of Birth
*
Phone Number
*
Email Address
*
Are you an existing Sovereign Insurance Services client?
Yes
No
ADDRESS
Street
Street Line 2
Street Line 3
State/Province
Country
*
Postal/Zip Code
VEHICLE DETAILS
Registration Number
Country of Registration
Make & Model
Engine Size
Year of Make
Value £
Cover Required
Fully Comprehensive
Third Party
Are You Currently Insured?
Yes
No
License Type
Full Gibraltar Licence
Provisional Gibraltar Licence
Full UK Licence
EU Licence
International
Other
License Type
Years Held
Current Insurers
Cover Start Date
No Claims Bonus
None
1 Year
2 Years
3 Years
4 Years
5+ Years
10+ Years
5+ Years Protected
Security
Alarm
Immobiliser
Tracker
Do you wish to include any of the below?
Green Card
Legal & Breakdown
Drivers
Insured Only
Insured and Spouse
Insured and 1 Named Driver
Insured and 2 Named Drivers
Insured and 3 Named Drivers
Any Driver Aged 25-70
Vehicle Kept
Garage
Drive
Road
Public Car Park
Private Car Park
Compound
Spain
Other
Vehicle Kept
ADDITIONAL DRIVERS
Additional Driver 1
Prefix
First Name
Middle Name
Last Name
License Type
Full Gibraltar Licence
Provisional Gibraltar Licence
Full UK Licence
EU Licence
International
Years Held
Additional Driver 2
Prefix
First Name
Middle Name
Last Name
License Type
Full Gibraltar Licence
Provisional Gibraltar Licence
Full UK Licence
EU Licence
International
Years Held
Additional Driver 3
Prefix
First Name
Middle Name
Last Name
License Type
Full Gibraltar Licence
Provisional Gibraltar Licence
Full UK Licence
EU Licence
International
Years Held
ADDITIONAL DETAILS
Have you or any driver had any accidents, claims or losses in the last 5 years?
*
Yes
No
If ‘Yes’ please provide full details
Have you or any driver had any convictions in the last 5 years?
*
Yes
No
If ‘Yes’ please provide full details
Any additional information
How did you hear about Sovereign Insurance Services?
*
Submit
×
