Household Quote

Date cover required from (dd/mm/yy)

Time (24h format)	Date (dd/mm/yy)
:
Cover will not become effective until this application form is accepted on behalf of Argus Insurance Company (Europe) LTD. The policy will be renewable annually.

Your personal details

	You	Your domestic partner/joint proposer
Title Mr/Mrs/Miss/Ms/Dr/Other (please specify)
First name(s)
Surname
Date of birth (dd/mm/yy)
Sex	Female Male	Female Male
House name or number
Street
Home telephone number
Work telephone number
Mobile telephone number
Email Address
Occupation/profession
Is the policy required in joint names?	Yes No

Your property details

Address of property to be insured
Is the property to be insured in Gibraltar?	Yes No
Approximate year the home was built
Is the property your main or permanent residence?	Yes No
If you have answered no, please indicate how the property is used.	Weekend home Weekday home Holiday home Other
Is the home:
Owned on a mortgage? Owned outright? Rented from the Local Authority? Rented from private landlord? Rented furnished? Rented unfurnished? Let unfurnished?
Is the home usually occupied/attended during daytime working hours?	Yes No
Is the home:	Detached? Terraced? Semi-detached? Block of flats?
Please indicate the type of property:
House Bungalow Self-contained flat (ground floor)^† Self-contained flat (other floor)^† Self-contained duplex
^† A self-contained flat has no shared facilities (kitchen, toilet, bathroom etc.) and has its own lockable entrance door from street, hall or landing.
What are the walls constructed of?	Brick, stone or concrete Granite or sandstone Other*
What is the roof constructed of?	Slates, tiles, asphalt, concrete or metal Other*
*If you have answered 'other' please give full details below.

Loyalty discount

We offer a premium discount of 10% for every additional personal insurance policy taken out with Argus. If you are already an Argus policyholder, please provide details (policy number)

Your loss history

Have you, or any person to be insured, or the property to be insured, suffered any loss, damage, injury or liability in the last five years (whether insured or not) from any of the events to be insured by this policy?

Yes No

If 'yes', please provide full details below.

Type of claim (E.g. Theft, Fire, Liability etc.)	Policy cover section (E.g. Contents, Buildings)	Date (dd/mm/yy)	Amount of claim (£)	Claim settled? (Yes/No)
				Yes No
				Yes No
				Yes No

Brief description of claim:

Cover details

Contents

Contents sum insured of your choice (minimum £15, 000)

Policy will automatically include the following extensions -

Clothing and Personal Effects - Unspecified	Maximum Limit £2000	Single Article Limit £400
Deep Freezer (Food Spoilage)	Maximum Limit £250
Pedal Cycles	Maximum Limit £250
Personal Money/Credit Cards	Maximum Limit £250

Important: the sum to be insured must represent the full cost of replacing all the contents insured, without allowance for wear and tear and loss in value, other than for clothing and household linen. If you need assistance calculating your sum insured, please contact us.

Valuables

Any valuables^† in the home which exceed the single article limit (i.e. 5% of the Contents sum insured or £2,000, whichever is the greater) must be specified below. If there is insufficient space below, please attach a separate sheet.

Note: Do not include any items insured separately under the Personal Belongings section.

^†Valuables comprise stamp, coin or medal collections, pictures, other works of art, articles of gold, silver or other precious metal, jewellery or furs.

Description	Item Value



If the total amount of valuables exceeds one-third of the sum insured under the Contents section, state value

Additional Cover details

Buildings Cover - only complete this section if Buildings cover is required.
Please state the sum you wish to be insured (minimum £35,000)
Important: The sum to be insured must represent the full cost of rebuilding the home to the present specification (including garages and Outbuildings) plus approximately 15% to cover demolition costs and architects' and surveyors' fees. Please state name and address of any interested party and nature of interest, e.g. your Mortgage Lender.
Nature of interest
Name and Address
Additional Covers required:
Higher Limits
Students living abroad
Legal Defence
Caravans

General questions

Is the home in a good state of repair?	Yes No
Will the home be maintained in a good state of repair?	Yes No
Is the home occupied by you, your domestic partner and family members of you and/or your domestic partner only, as a private dwelling (not used for business or professional purposes or having internal access to business premises)?	Yes No
Does the home have any sign of damage by subsidence, heave or landslip?	Yes No
Has the home ever been damaged by subsidence, heave, landslip or flood, been underpinned or had any remedial or preventative action of any type in respect of these events?	Yes No
Is the home in an area exposed to damage by storm or flood?	Yes No
Have you or any person to be insured:
a. ever had a proposal for insurance declined, renewal refused, cover terminated, increased premium required or special conditions imposed by any insurer?	Yes No
b. ever been convicted of or cautioned for (or charged but not yet tried with) any criminal offence other than motoring offences?	Yes No
Is the home likely to be left unoccupied for more than 60 consecutive days in any one year?	Yes No
Do you undertake to advise us if the sum(s) insured under this policy become inadequate?	Yes No

Declaration

I/We hereby declare that to the best of my/our knowledge and belief the above statements and particulars are true and correct and that I/we have not withheld any information material to the Proposal whether the subject of a proposal form question or not. I/We agree to accept and conform to the terms of the policy when issued. I/We undertake that the vehicles to be insured shall not by driven by any person who to my/our knowledge has been refused Motor Vehicle Insurance or continuance thereof.

Important

All material facts must be disclosed. Failure to do so could invalidate the policy. A material fact is one likely to influence an Insurer in the assessment and acceptance of the proposal (e.g. any criminal conviction concerning dishonesty). If you are in any doubt as to whether a fact is material then it should be disclosed to the Insurer.

Complaints Procedure

Our aim is at all times to provide a first class service. However, there may be occasions when you feel that this objective has not been achieved. Should you have any query or complaint regarding this insurance please contact either your local adviser or write to the Argus Insurance Company (Europe) Limited, Regal House, 3 Queensway, Gibraltar.

Argus Insurance fully complies with the FSC regulations in respect of the Distance Marketing Act 2006. For full details of this, please visit www.fsc.gi.
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