HOMEOWNERS QUOTE Please enable JavaScript in your browser to complete this form.Name *FirstLastOccupationAddressEmail *Phone NumberType of Building StructureConcreteWoodenConcrete & WoodLocation of buildingStory1 Story2 Stories3 StoriesConstruction PeriodFor unstrcuted or building underconstruction.Type of FloorWoodConcreteWhat Percentage is Wood?What Percentage is Concrete?Distance to nearest water SourceAny building within 20ft ?Type of RoofZincConcreteShinglesGalvanizeOtherHow many days (whether consecutive or not) is the dwelling likely to be left without an inhabitant during one year?Less than 30 daysMore than 30 daysNote: Attention is drawn to a proviso in the Policy that cover against Bursting or Overflowing of Water Tanks, Apparatus or Pipe and Burglary &/or Theft will be suspended for any period or periods in excess of Thirty (30) days during which the dwelling is left without an inhabitant therein unless specially agreed to by the Company.Year of Construction/ RenovationValueAssigneeBank of InterestBroker's CommentsInsurerPeriodPremiumDeductible(s)Submit Return to Quotations
