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© 2025 Prestige Insurance Brokers (UK) Limited

Fact find questionnaire

for HIGH VALUE HOUSEHOLDS

FILL OUT THE FORM BELOW TO GET AN INSURANCE QUOTE

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Contact Name

Email

Phone number

Please provide a correspondence address (If it is different from the address being insured)

Insurance Renewal date

Current insurer

Premium target

Property Ownership Name

Land Registry Title

Owners, Partners or Directors details: Provide full names / DOB/ Occupation/ Relationship to the proposer

Please select from the following options that apply to any Owner, Director, or Partner:

have been declared bankrupt or insolvent or been a subject of bankruptcy proceedings
had any non-motor conviction or criminal offences or any prosecutions pending
have been the subject of a recovery action by Customs and Excise or the Inland Revenue
have ever entered into an arrangement with their creditors
had a County Court Judgement awarded against them
Not applicable

Please select from the following options that apply to any Owner, Director, or Partner:

had an insurance renewal refused
had an insurance cancelled by an insurer
had been asked to take extra precautions by insurers
had any special insurance terms imposed
Not applicable

Full address of the premises to be insured

(Property Name, Building Number, Street name, Town & Post code)

Type of building

Year property built

Year property purchased

Type of residence

Number of bedrooms

Is the property a Listed building?

Yes
No

Please provide details:

Please select from the following options that apply to the premises:

The property is not self contained with its own means of access
The property is erected on made up ground or has been underpinned
The property is in area with history of flooding
The property is unduly exposed to storms or high winds
The property is close to mines/underground workings
The property has suffered from, or shows any visible signs of damage subsidence, landslip or ground heave
Not applicable

Is the premises in a good state of repair and free from damage?

Yes
No

Is the property of non-standard construction?

Yes
No

(Walls not built only of brick, stone, concrete or roofed only with slates, tiles, or concrete)

What is the total number of storeys in the building?

Number of storeys where floor is of concrete construction?

Number of storeys where floor is of wooden construction?

Does the property have a basement?

Yes
No

What main materials are the property walls made of?

Please provide percentage split, if the walls are made of more than one material

Does the premises have external cladding/external wall insulation?

Yes
No

What materials is the property roof made of?

Please provide percentage split, if the roof is made of more than one material

Is there any area of the roof flat?

Yes
No

Please state the approximate percentage of the roof being flat?

What type of heating is currently installed in the property?

Please select Risk Management Features that are currently active for this property:

Intruder Alarm
Wired Fire Alarm
Smoke detectors
Sprinklers
Gas inspections
Electrical inspections

What type of signalling the Intruder Alarm has?

Redcare
Digicom
Bells only
Other

Is the Intruder Alarm connected to the Police response?

Is this Intruder Alarm being regularly maintained by contracted Accreditation Approved Company?

Yes
No

Please provide details:

Are the sprinklers installed with a water supply?

Yes
No

Are the Sprinklers maintained by Loss Prevention Certification Board approved company?

Yes
No

Sprinklers accreditation details:

Please select Security Aids that are currently active for this property:

24-hour manned security
All accessible windows, fanlights and skylights are fitted with key operated locks
All final exit doors are fitted with at least 5 lever mortice deadlocks
Private CCTV (recording 30 days)
Disaster plan in place
External lighting
Fire alarm
Smoke alarms
Intruder Alarm
None

Fire alarm type

Intruder alarm

Intruder alarm response type

Provide details, Police response level etc

Premises occupancy type:

Personal
Commercial
Residential
Commercial and Residential

What is the total number of tenancies on this premises?

Please specify all tenancies and trades in the commercial area of the premises:

Please specify number of tenancies and type of tenants in the residential area on the premises:

I.e: Working tenants, Students, Benefit Assisted)

Is any part of the property a House in Multiple Occupation (HMO)?

Yes
No

Is any part of the premises unoccupied?

Yes
No

Reason for unoccupancy

Length of expected unoccupancy

Percentage of the premises that is unoccupied

Date property first unoccupied

Previous occupant type

Please select immediate intention for the property:

Letting
Development
Demolition
Owner occupied
Sale
Unknown

Any type of work planned?

Decoration
Extension construction
Central heating installation
Conversion to private dwelling
Kitchen/Bathroom refit
Major structural works
Non-structural major refit
Refurbishment/Renovations
Replacing windows
Replumbing
Rewiring
None

Is planning permission granted?

Yes
No

Contract works value (£)

Type of structural works:

Reinstatement sum of the buildings?

Please provide the estimate based on the most recent survey or within the lat 5 years.

Reinstatement sum of the indoor contents

Reinstatement sum of outdoor contents

Reinstatement of the valuables (Unspecified)

Reinstatement sum of specified items. Please specify: Item type / Description / Sum insured (£)

Please provide the estimate based on the most recent survey or within the lat 5 years.

Required limit of indemnity for Public Liability

Required limit of indemnity for Legal Expenses

Have you had any losses or incidents giving rise to a claim in the last 5 years?

Yes
No

Please provide the details of the claims made: (Date of claim, Cause of the Claim, The Claim Amount & the Outcome)

Any additional information?

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© 2025 Prestige Insurance Brokers (UK) Limited - Appointed Representative of TEn Insurance Services Ltd, trading as Eleven, which is authorised and regulated by the Financial Conduct Authority (FRN 314593)