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Find out why more people are turning to West Craven Insurance

Please complete the details below as fully as possible.

Proposer details

* Title:

* First names:

* Last name:

* Email address:

* Daytime tel no:

* Postal address:

* Postcode:

Date of birth: D: M: Y:

Age:

Your occupation (include any part-time work):

Nature of employers business (or own if self-employed):

Your Partner / Joint Proposer

Title:

First names:

Last name:

Date of birth: D: M: Y:

Age:

Their occupation (include any part-time work):

Nature of employers business (or own if self-employed):

Your history

Construction of property: BrickStoneConcreteOther

If other please give details:

Type of property: Detached houseSemi-detached houseTerraced houseOtherBungalow detachedBungalow semi-detachedBungalow terracedOther

If other please give details:

Number of bedrooms:

Cover Required: BuildingsContentsBuildings & Contents

Buildings sum insured:

Contents sum insured:

If the property to be insured differs from your postal address above, please state the address and reason for the difference

Address of house to be insured:

Postcode:

Reason for difference:

Do you have a claims history (within 5 years)? YesNo

If you ticked yes, you must fill in the section below:

Date: D: M: Y:

Details of loss:

Amount:

By providing your email address, you are happy to allow contact from the advertiser about your query.