Insurance Application

Please provide your contact details and particulars of the property to be insured in the form below:-

*ALL fields require completion Type of Insurance Cover Required:
Name:
Day, Month & Year of Birth:

Email:
Telephone No:
Address:
Year Built:
Is the Home of Standard Construction? (Of brick / stone with tile or slate roof - Answer Yes, otherwise No) Free from any History of Flooding or Subsidence?
Select 'Yes' if You Have *NOT* Sustained
any Loss or Damage in the last 3 Years..
*ONLY if you have answered NO to ANY of the above 3 questions,
Please give further details in each case below:- Will the Property be used for Commercial Letting? *If YES, accidental damage cover CANNOT be granted
on the contents section. Building Sum Insured: *This should represent the rebuilding cost of the property
and not the resale value. Accidental Damage Cover?
Contents Sum Insured:
Accidental Damage Cover?
Cover Start Date - Day, Month & Year of Commencement:
*All our quotes are valid only for a period of 30 days.
Response Preferences:
*Before submitting this form you must ensure you have first...
Read and agreed to our terms and conditions of business
and also please indicate you have done so below:- Agreement of Terms:

Please do not hesitate to contact us if you need further information on your application

C. Jones-Evans and Son - Holiday Home Insurance Specialists
Hope House, 35 High Street, Pwllheli, Gwynedd, LL53 5RT
Tel: 01758 612546 - Fax: 01758 701373

Insurance Application

Please provide your contact details and particulars of the property to be insured in the form below:-

Please do not hesitate to contact us if you need further information on your application

C. Jones-Evans and Son - Holiday Home Insurance Specialists Hope House, 35 High Street, Pwllheli, Gwynedd, LL53 5RT Tel: 01758 612546 - Fax: 01758 701373

C. Jones-Evans and Son - Holiday Home Insurance Specialists
Hope House, 35 High Street, Pwllheli, Gwynedd, LL53 5RT
Tel: 01758 612546 - Fax: 01758 701373