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.

Client Details

What is the renewal or expected start date of this policy

Please list ALL policyholders as you would like them to appear on the policy document (eg. this can be an individual, multiple people, multiple freeholders or a company name)

Main Contact:

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

Telephone Number

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

Email address

Policy Address:

Please enter the postcode of your correspondence address

Address 1

Address 2

City

County

Are you domiciled within the United Kingdom, the Channel Islands or the Isle of Man?

Please provide details of your domicile

Do you have a UK Bank Account?

Do you have a UK Representitive responsible for checking on the property?

Please provide a target premium if you have one

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

Additional Information:

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 *

Coverage available for single or multiple properties
£5k free contents for certain types of let
Free malicious damage cover for some lets with upgrades available to include theft
Loss of rent covered as standard if the property becomes uninhabitable
£5m public liability cover automatically included
Competitive premiums, with options to renew if required