Business Insurance · Personal Insurance · Wakefield, West Yorkshire · Commercial Landlords

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If you have more than 10 properties please call 01924871111

Name(Required)

First & Last

Date of Birth(Required)

DD slash MM slash YYYY

Address(Required)

(Correspondence Address)

Street Address City Postcode

Phone(Required)

Personal Details

Proposer Type(Required)

Does The Proposer Reside Predominantly in England, Scotland, Wales, Northern Ireland or Isle of Man?(Required)

Yes

Date Policy to Start(Required)

MM slash DD slash YYYY

Personal History

Have you Been Convicted of Any Criminal Offences( Excluding Driving Offences) ?(Required)

Yes

Please State(Required)

Have You or anyone in your Company Benn Declared Bankrupt or Gone into Liquidation?(Required)

Yes

Please State(Required)

Have you Ever Been Declined, Refused or had Your Insurance Cancelled?(Required)

Yes

Please State(Required)

Have you Had any Claims in the Last 5 Years?(Required)

Yes

Please State(Required)

Property Details

Number of Properties to be insured?

Please enter a number from 1 to 10.

If you have more than 10 properties please call 01924 871111

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Property 1

Address(Required)

Street Address City ZIP / Postal Code

Owned Since?(Required)

Year Built?(Required)

Flat roof % ?(Required)

Building Sums Insured?(Required)

Building Type?(Required)

Type of Property?(Required)

Let

Vacant

Number of Tenants(Required)

Annual Rent(Required)

Tenant type(Required)

Please select all that apply

Food & Drink Manufacturers

Food Establishment

Hotels / Guest Houses

Manufacturing / Repair / Servicing

Miscellaneous Risks

Motor Trade

Offices

Printing Trades

Shops

Surgery

Warehouse / Storage / Supply

Pubs / Clubs /Halls / Leisure

Other Not Listed

Please State:(Required)

The Lease Agreement is Between You and(Required)

Duration of Lease Agreement(Required)

Does the Lease Allow your Tenant to Sub-let(Required)

Yes

Are the Current Tenants in Rent Arrears and/or Subject to Eviction Proceedings?(Required)

Yes

Property 2

Address

Street Address City ZIP / Postal Code

Owned Since?(Required)

Year Built?(Required)

Flat roof % ?(Required)

Building Sums Insured?(Required)

Building Type?(Required)

Type of Property?(Required)

Let

Vacant

Number of Tenants(Required)

Annual Rent(Required)

Tenant type(Required)

Please select all that apply

Food & Drink Manufacturers

Food Establishment

Hotels / Guest Houses

Manufacturing / Repair / Servicing

Miscellaneous Risks

Motor Trade

Offices

Printing Trades

Shops

Surgery

Warehouse / Storage / Supply

Pubs / Clubs /Halls / Leisure

Other Not Listed

Please State:

The Lease Agreement is Between You and(Required)

Duration of Lease Agreement(Required)

Does the Lease Allow your Tenant to Sub-let(Required)

Yes

Are the Current Tenants in Rent Arrears and/or Subject to Eviction Proceedings?(Required)

Yes

Property 3

Address

Street Address City ZIP / Postal Code

Owned Since?(Required)

Year Built?(Required)

Flat roof % ?(Required)

Building Sums Insured?(Required)

Building Type?(Required)

Type of Property?(Required)

Let

Vacant

Number of Tenants(Required)

Annual Rent(Required)

Tenant type(Required)

Please select all that apply

Food & Drink Manufacturers

Food Establishment

Hotels / Guest Houses

Manufacturing / Repair / Servicing

Miscellaneous Risks

Motor Trade

Offices

Printing Trades

Shops

Surgery

Warehouse / Storage / Supply

Pubs / Clubs /Halls / Leisure

Other Not Listed

Please State(Required)

The Lease Agreement is Between You and(Required)

Duration of Lease Agreement(Required)

Does the Lease Allow your Tenant to Sub-let(Required)

Yes

Are the Current Tenants in Rent Arrears and/or Subject to Eviction Proceedings?(Required)

Yes

Property 4

Address

Street Address City ZIP / Postal Code

Owned Since?(Required)

Year Built?(Required)

Flat roof % ?(Required)

Building Sums Insured?(Required)

Building Type?(Required)

Type of Property?(Required)

Let

Vacant

Number of Tenants(Required)

Annual Rent(Required)

Tenant type(Required)

Please select all that apply

Food & Drink Manufacturers

Food Establishment

Hotels / Guest Houses

Manufacturing / Repair / Servicing

Miscellaneous Risks

Motor Trade

Offices

Printing Trades

Shops

Surgery

Warehouse / Storage / Supply

Pubs / Clubs /Halls / Leisure

Other Not Listed

Please State(Required)

The Lease Agreement is Between You and(Required)

Duration of Lease Agreement(Required)

Does the Lease Allow your Tenant to Sub-let(Required)

Yes

Are the Current Tenants in Rent Arrears and/or Subject to Eviction Proceedings?(Required)

Yes

Property 5

Address

Street Address City ZIP / Postal Code

Owned Since?(Required)

Year Built?(Required)

Flat roof % ?(Required)

Building Sums Insured?(Required)

Building Type?(Required)

Type of Property?(Required)

Let

Vacant

Number of Tenants(Required)

Annual Rent(Required)

Tenant type(Required)

Please select all that apply

Food & Drink Manufacturers

Food Establishment

Hotels / Guest Houses

Manufacturing / Repair / Servicing

Miscellaneous Risks

Motor Trade

Offices

Printing Trades

Shops

Surgery

Warehouse / Storage / Supply

Pubs / Clubs /Halls / Leisure

Other Not Listed

Please State(Required)

The Lease Agreement is Between You and(Required)

Duration of Lease Agreement(Required)

Does the Lease Allow your Tenant to Sub-let(Required)

Yes

Are the Current Tenants in Rent Arrears and/or Subject to Eviction Proceedings?(Required)

Yes

Property 6

Address

Street Address City ZIP / Postal Code

Owned Since?(Required)

Year Built?(Required)

Flat roof % ?(Required)

Building Sums Insured?(Required)

Building Type?(Required)

Type of Property?(Required)

Let

Vacant

Number of Tenants(Required)

Annual Rent(Required)

Tenant type(Required)

Please select all that apply

Food & Drink Manufacturers

Food Establishment

Hotels / Guest Houses

Manufacturing / Repair / Servicing

Miscellaneous Risks

Motor Trade

Offices

Printing Trades

Shops

Surgery

Warehouse / Storage / Supply

Pubs / Clubs /Halls / Leisure

Other Not Listed

Please State(Required)

The Lease Agreement is Between You and(Required)

Duration of Lease Agreement(Required)

Does the Lease Allow your Tenant to Sub-let(Required)

Yes

Are the Current Tenants in Rent Arrears and/or Subject to Eviction Proceedings?(Required)

Yes

Property 7

Address

Street Address City ZIP / Postal Code

Owned Since?(Required)

Year Built?(Required)

Flat roof % ?(Required)

Building Sums Insured?(Required)

Building Type?(Required)

Type of Property?(Required)

Let

Vacant

Number of Tenants(Required)

Annual Rent(Required)

Tenant type(Required)

Please select all that apply

Food & Drink Manufacturers

Food Establishment

Hotels / Guest Houses

Manufacturing / Repair / Servicing

Miscellaneous Risks

Motor Trade

Offices

Printing Trades

Shops

Surgery

Warehouse / Storage / Supply

Pubs / Clubs /Halls / Leisure

Other Not Listed

Please State(Required)

The Lease Agreement is Between You and(Required)

Duration of Lease Agreement(Required)

Does the Lease Allow your Tenant to Sub-let(Required)

Yes

Are the Current Tenants in Rent Arrears and/or Subject to Eviction Proceedings?(Required)

Yes

Property 8

Address

Street Address City ZIP / Postal Code

Owned Since?(Required)

Year Built?(Required)

Flat roof % ?(Required)

Building Sums Insured?(Required)

Building Type?(Required)

Type of Property?(Required)

Let

Vacant

Number of Tenants(Required)

Annual Rent(Required)

Tenant type(Required)

Please select all that apply

Food & Drink Manufacturers

Food Establishment

Hotels / Guest Houses

Manufacturing / Repair / Servicing

Miscellaneous Risks

Motor Trade

Offices

Printing Trades

Shops

Surgery

Warehouse / Storage / Supply

Pubs / Clubs /Halls / Leisure

Other Not Listed

Please State(Required)

The Lease Agreement is Between You and(Required)

Duration of Lease Agreement(Required)

Does the Lease Allow your Tenant to Sub-let(Required)

Yes

Are the Current Tenants in Rent Arrears and/or Subject to Eviction Proceedings?(Required)

Yes

Ninth Property

Address

Street Address City ZIP / Postal Code

Owned Since?(Required)

Year Built?(Required)

Flat roof % ?(Required)

Building Sums Insured?(Required)

Building Type?(Required)

Type of Property?(Required)

Let

Vacant

Number of Tenants

Annual Rent(Required)

Tenant type(Required)

Please select all that apply

Food & Drink Manufacturers

Food Establishment

Hotels / Guest Houses

Manufacturing / Repair / Servicing

Miscellaneous Risks

Motor Trade

Offices

Printing Trades

Shops

Surgery

Warehouse / Storage / Supply

Pubs / Clubs /Halls / Leisure

Other Not Listed

Please State(Required)

The Lease Agreement is Between You and(Required)

Duration of Lease Agreement(Required)

Does the Lease Allow your Tenant to Sub-let(Required)

Yes

Are the Current Tenants in Rent Arrears and/or Subject to Eviction Proceedings?(Required)

Yes

Tenth Property

Address

Street Address City ZIP / Postal Code

Owned Since?(Required)

Year Built?(Required)

Flat roof % ?(Required)

Building Sums Insured?(Required)

Building Type?(Required)

Type of Property?(Required)

Let

Vacant

Number of Tenants

Annual Rent(Required)

Tenant type(Required)

Please select all that apply

Employed / Self Employed

Retired

Housing Benefit Recipient

Student

Asylum Seeker

Owner Occupied

Other

Please State(Required)

The Lease Agreement is Between You and(Required)

Duration of Lease Agreement(Required)

Does the Lease Allow your Tenant to Sub-let(Required)

Yes

Are the Current Tenants in Rent Arrears and/or Subject to Eviction Proceedings?(Required)

Yes

Commercial Landlords

If you have more than 10 properties please call 01924871111

Personal Details

Personal History

Property Details

Property 1

Property 2

Property 3

Property 4

Property 5

Property 6

Property 7

Property 8

Ninth Property

Tenth Property

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