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Home Insurance Questionnaire
Before you start
We use this information to obtain accurate home insurance quotes for you. Your details will be stored securely and shared only with insurers where required. If you are unsure on any question, please do not hesitate to reach out.
Proposer Details
Full Name
(Required)
First
Last
Email Address
(Required)
Email Address
Confirm Email Address
Mobile Number
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Do you want another applicant on the policy? If yes, complete below:
Full Name
(Required)
First
Last
Email Address
(Required)
Email Address
Confirm Email Address
Mobile Number
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Property Address & Occupancy
1. Property Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
2. Is this your main residence?
(Required)
Yes
No
Is the property:
(Required)
Second home
Holiday home
Buy-to-let
3. When was the property built?
(Required)
Pre-1900
1900–1949
1950–1999
2000 onwards
Not sure
Property Type & Construction
1. Property type
(Required)
Detached
Semi-detached
Terraced
Flat / Apartment
Bungalow
Floor level:
(Required)
Number of floors in the building:
(Required)
2. Construction type
Walls:
(Required)
Brick
Stone
Timber
Other
Roof:
(Required)
Please tick all that apply
Tile
Slate
Flat
Other
Please provide details
(Required)
Please state the approximate percentage of the roof that is flat.
(Required)
3. Number of bedrooms
(Required)
4. Is the property:
(Required)
Standard construction
Non-standard construction
Please provide details
(Required)
Property Use
1. Who lives at the property? (tick all that apply)
(Required)
Owner(s)
Family members
Lodger(s)
Tenant(s)
2. Is the property ever left unoccupied for more than 30 consecutive days?
(Required)
Yes
No
Reason
(Required)
Typical duration
(Required)
3. Is any part of the property used for business purposes?
(Required)
Yes
No
Type of business
(Required)
Area used (e.g. spare room)
(Required)
Buildings Insurance
1. Do you require buildings insurance?
(Required)
Yes
No
2. Estimated rebuild cost
(If unsure, we can help calculate this)
3. Has the property been extended or structurally altered?
(Required)
Yes
No
Type of work
(Required)
Year completed
(Required)
4. Is the property protected by any of the following?
(Required)
Burglar alarm
Window locks
Door locks
CCTV
None
Contents Insurance
1. Do you require contents insurance?
(Required)
Yes
No
2. Estimated total value of contents (£)
(Required)
(Include furniture, electronics, clothing, etc.)
3. Any high-value items?
(Required)
Yes
No
(single items over £1,500)
For each item:
(Required)
Description
Value (£)
Kept at home? (Yes/No)
Add
Remove
4. Do you require cover for personal possessions outside the home?
(Required)
Yes
No
Claims History
1. Have you or anyone living at the property made any home insurance claims in the last 5 years?
(Required)
Yes
No
For each claim:
(Required)
Year
Type of claim (e.g. escape of water, theft)
Amount claimed (£)
Was the claim settled? (Yes/No)
Add
Remove
Flooding, Subsidence & Risk
1. Has the property ever been affected by: (tick all that apply)
(Required)
Flooding
Subsidence / heave / landslip
Unsure
None
Please do not select “None” if another option applies.
Year
(Required)
Cause
(Required)
Any remedial work completed?
(Required)
Yes
No
Cover Preferences
1. Preferred level of excess (£)
(Required)
Standard
Higher excess to reduce premium
No preference/please advice.
2. Do you need cover to start on a specific date?
(Required)
Yes
No
Start date
(Required)
MM slash DD slash YYYY
Do you need a third party, such as a mortgage lender, listed on the policy? If so, please provide details.
3. Any additional requirements or concerns?
Declaration & Consent
By submitting this form, you confirm the information provided is accurate and complete to the best of your knowledge. You consent to Marlow Mortgage contacting you regarding home insurance and related services.
(Required)
I confirm and agree
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