Holiday Home Insurance Quotation Form                                                Your Details  Name  Address  Telephone  Email address  Occupation  Date of birth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Property Details   Address of property to be insured (if   different  from above address)  Type of property Detached Semi-detached Terraced Bungalow Apartment   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 a family up to 6 working persons sharing up to 6 students sharing holidaymakers (on a weekly basis)   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:   walls   roof   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 seasonal year round  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:  buildings €  contents €  Personal Items to be insured away from the home.  Unspecified valuables under €1300 each  Total €   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 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010