Please answer the questions set out below accurately and completely.

For your convenience, we may have included certain answers in the form however you must change these answers if they are inaccurate. This may result in us requiring further underwriting information, but may not preclude us from providing cover. You must notify us of any changes to the information provided. You must answer all questions accurately and completely. You must provide us with all further information we request and any other information of which we should be made aware.

About You

Your Personal Details:

This policy is ONLY appropriate if the property to be insured is occupied solely by you and your immediate family as your main residence. If the property is a Freehold, a holiday or 2nd home or you are a landlord, please click here. If the property is unoccupied, please click here.

Who primarily occupies the property as their main residence?

You & Your Family
Tenants
Freeholders
Unoccupied
Holiday/2nd Home not main residence

Do you wish to charge an additional policy fee (This will be added to the quote/schedule)

You must be a UK Resident & the Property needs to be in the UK

Confirm
Cannot Confirm

Title

These should be the details of the main proposer, who must be the owner of the property and/or contents to be insured.

First Name

Surname

How would you like us to refer to you?

Date of Birth

Marital Status

Please enter the postcode of your correspondence address

This should be the postcode of your correspondence address.

Policy Address:

Address 1

Address 2

City

County

Contact Details:

Telephone Number

Please note we will only contact you regarding admininstration of your policy unless otherwise agreed by you.

Your email address:

Please enter your email address so that we can send you your quotation and documentation, and details of other offers if you have chosen this option.

Occupation

Please begin to type your job title into the 'main occupation' box, then, from the dropdown, select the occupation which is the closest match.

Would you like to add a joint policyholder?

To be a joint policyholder the person must either own the home you wish to insure and/or its contents jointly with you, or own part of the home you wish to insure and/or some of its contents.

Title

First Name

Surname

Date of Birth

CCJs/IVAs:

Have any members of the household had a County Court Judgement, Sheriff Court Decree or been the subject of any bankruptcy or winding up proceedings?

Please record further information about the CCJ/Bankruptcy

Convictions:

Have any members of the household had any prior or pending criminal convictions (other than motoring)?

What was the conviction for?

What was the date of the conviction?

Length of sentence from?

Length of sentence to?

Details of fines of community service?

Is there a prosecution pending?

Please record further information about the Convictions

Refused or had cover cancelled or voided:

Have any members of the household ever had insurance refused, declined, cancelled or had special terms imposed?

Please record further information about the Previous Insurance Refusal/Cancellation

Additional Information:

How many years have you continuously held home insurance?

How did you hear about us?

I’m happy for Emerald Life to send me information about their products and services including discounts on further purchases?

Promotional Code - please enter if applicable

Key Benefits *

Up to £1,500,000 of home insurance and up to £150,000 of contents online. Call us on 0330 113 7109 for higher levels
FREE Legal & Home Emergency cover automatically included
Accommodation cover up to 24 months while your house is repaired
Optional accidental damage cover including damage by pets
Legal expense cover for any form of illegal discrimination

* for standard home & contents policies