Risk Submission
Please note that all fields marked with a "
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" are compulsory.
1. Details
1a: Your/Company Details
Agency Code
Company Name
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Contact Name
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Day Telephone No.
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Email Address
1b: Insured Details
Insured Name
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2. Property A
2a: Property Details
Risk Address Line 1
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Risk Address Line 2
Town
County
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Postcode
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Type of Property
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Select
Private Dwelling House/Bungalow
Flats - Modern/Purpose Built
Flats - Converted/Wooden Floored
Type of Tenant
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Select
Asylum Seekers
DSS/DWP
Holiday Let
Housing Association
Owner Occupied
Professional
Students
Vacant/Unoccupied
If the property is vacant, please answer the questions below
Why is the Property Vacant
Select
In between tenants
Under refurbishment
Other
How long has the property been unoccupied
How long is it estimated it will remain vacant
What security is in place?
5 lever mortice deadlocks on final exit doors
yes
no
Key operated locks on windows
yes
no
Intruder alarm system, with remote signalling
yes
no
Intruder alarm system, bells only
yes
no
Other security
2b: Construction
Age of Property
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Select
Pre 1851
1851-1899
1900-1944
1945-1979
1980-1989
1990 or later
Is the Property Listed?
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Select
No
Grade I
Grade II
Construction of Walls
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Select
Brick
Brick/Timber Frame
Cob
Concrete
Flint
Other
Stone
Wattle and Daub
Construction of Roof
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Select
Flat
Other
Slate
Thatched Fibre
Thatched Reed
Tile
If the roof is flat, please answer the questions below
What Percentage is Flat?
Select
50% or less
More than 50%
What is the construction of the flat roof?
Select
Concrete
Asphalt re-roofed >10 yrs Under Guarantee
Asphalt re-roofed >10 yrs No Guarantee
Asphalt re-roofed <10 yrs Under Guarantee
Asphalt re-roofed <10 yrs No Guarantee
Felt on Timber re-roofed >10 yrs Under Guarantee
Felt on Timber re-roofed >10 yrs No Guarantee
Felt on Timber re-roofed <10 yrs Under Guarantee
Felt on Timber re-roofed <10 yrs No Guarantee
Bitumen re-roofed >10 yrs Under Guarantee
Bitumen re-roofed >10 yrs No Guarantee
Bitumen re-roofed <10 yrs Under Guarantee
Bitumen re-roofed <10 yrs No Guarantee
Other
3. Other information for Property A
3a: Cover Required
Buildings Declared Value/Rebuild Value £
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Buildings Cover
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Select
With Accidental Damage Cover
Without Accidental Damage Cover
Cover not required
Landlords Contents Sum Insured £
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Contents Cover
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Select
With Accidental Damage Cover
Without Accidental Damage Cover
Cover not required
Terrorism Cover
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yes
no
Rent Guarantee
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yes
no
Legal Expenses
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yes
no
Emergency Assistance
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yes
no
12 months loss of rent
3b: Claims Experience
Have there been any claims settled or submitted or any incidents that could give rise to a claim in the last five years?
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Select
yes
no
If you answered "yes", please answer the questions below
If you have more than 3 claims please contact your BIBALet Customer Service team on 01420 471987
Claim 1
Date of Loss
Amount Paid £
Amount Outstanding £
Type of Loss
What action has been taken to avoid recurrence
Claim 2
Date of Loss
Amount Paid £
Amount Outstanding £
Type of Loss
What action has been taken to avoid recurrence
Claim 3
Date of Loss
Amount Paid £
Amount Outstanding £
Type of Loss
What action has been taken to avoid recurrence
3c: Interested Parties
Lender's Details
Mortgage Ref
To add details of another Property click
4. Statement of Fact
Has the proposed insured person(s) or any owners of the proposed insured property including adult members of their immediate family, ever had a situation whereby a proposal to insure has been declined or had special terms imposed?
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yes
no
Has the proposed insured person(s) or any owners of the insured property, including adult members of their immediate family, ever been convicted, (or charged but not yet tried), for any offence other than driving offences?
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yes
no
Is the property to be insured in a good state of repair and will it be maintained at all times?
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yes
no
Is the property to be insured self-contained?
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yes
no
Will the property to be insured only be used for residential purposes and no business use other than paperwork, telephone calls and computer work?
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yes
no
If the property insured is left unoccupied for more than 30 consecutive days will it be inspected fully at least once every 14 days?
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yes
no
To the best of your knowledge, prior to commencing this insurance, are there any existing problems or any other circumstances known as likely to occur that might give rise to a claim under this insurance?
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yes
no
5. Promotional Code
Promotional Code
Your Promotional Code
