Hencilla Canworth
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Home Insurance

Request a quote for Home Insurance

Please complete and return this questionnaire so we can apply to our panel of insurers for a quote on your behalf. If you have a query regarding how to answer any of the questions please call us on 020 8686 5050.

After submission of the form it may be necessary for us to contact you for additional information to secure a quotation. The information provided will form the basis of your contract with the insurers so it is important that it is accurate.

If you provide false or inaccurate information, withhold information or fail to inform us of any relevant details the policy issued could be cancelled, declared void or the insurers could refuse to pay a claim.

* Required.

You, Proposer
Proposer History

Have you or any other proposer(s) or permanent members of the home to which this insurance may apply

Premises Type
Premises Occupancy
Business Use
Property Description
Roof Construction
Security
Subsidence, Landslip, Heave and Flood
Claims and Losses
  • £
  • £
  • £
  • £
  • £
  • £
Cover Required
Please detail the items below:
  • £
  • £
  • £
  • £
Valuables and Personal Belongings
  • £
    £
Please detail the items below:
  • £
  • £
  • £
  • £
  • £
Additional Details

* Required.