Holiday Home Insurance Quotation Form
                                             Your Details
 Email address
 Date of birth
Property Details
  Address of property to be insured (if   different  from above address)
 Type of property
  Is this property
  your main residence   Yes No
  a holiday home   Yes No
  owner occupied   Yes No
  accomodation rented by you   Yes No
  rented to tenants   Yes No
  If the property is rented to tenants,            describe the tenants
  Is the house totally of standard   construction   i.e. built of   brick/stone/concrete & roofed  with   slates/tiles     Yes No
  If the answer is No, state type of construction:
  timberframed   Yes No
  other (please state)
  Has any portion of the house a flat roof of   mineral felt and timber Yes No
   If so, give percentage roofed like this
  Year Built
  No. of Bedroom
  Alarm installed Yes No
  If so, NSAI approved & fitted Yes No Not Sure
  If so, connected to central monitoring station Yes No Not Sure
  Security locks on doors Yes No
  Security locks/bolts on windows Yes No
  Smoke alarms fitted Yes No
  if so, how many
 Neighbourhood watch/Community alert area Yes No Not Sure
 Is the house normally unoccupied during   the  day   Yes No
 Is the house normally occupied during the  night      Yes No
 Do you keep "Paying" guests    Yes No
 If so, maximum number any one time
 Is this done on a seasonal or year round basis
 Is any of the house used for business   purposes Yes No
 If so, give details
Cover Required
  Please state how much your house and contents are to be insured for:
 Personal Items to be insured away from the home.
 Unspecified valuables under 1300 each
  Specified valuables over 1300 each
   Item Description            Value :- €
 Any claims made in the last five years Yes No
 If so, give details
 If you have Motor Insurance, what company  are you insured with
 What is your present Home Insurance  company
 Renewal date of existing policy