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Mobile Number:

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Email Address:

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When would you like cover to begin:

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First line of address:

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Post code:

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Rebuilding sum insured:

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Buildings Rate Percentage SAGIC:

Buildings Rate Percentage MIRAMAR Level 1:

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Buildings Premium SAGIC:

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Accidental Damage Loading SAGIC:

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Buildings Premium SAGIC:

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Sum Insured Discounts SAGIC:

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Sum Insured SAGIC:

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Increased Excesses Discount SAGIC:

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Buildings Premium Excl. IPT SAGIC:

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Contents sum insured:

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Contents Rate Percentage SAGIC:

Contents Rate Percentage MIRAMAR Level 1:

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Contents Premium SAGIC:

Contents Premium MIRAMAR Level 1:

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Do you wish to include accidental damage cover:

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Accidental Damage Loading SAGIC:

Accidental Damage Loading MIRAMAR Level 1:

Accidental Damage Loading MIRAMAR Level 3:

Contents Premium SAGIC:

Contents Premium MIRAMAR Level 1:

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Sum Insured Discounts SAGIC:

Sum Insured Discounts MIRAMAR Level 1:

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Sum Insured SAGIC:

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Do you have a professionally fitted alarm at the property:

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Alarm Discount SAGIC:

Alarm Discount MIRAMAR Level 1:

Alarm Discount MIRAMAR Level 3:

Contents with Alarm Discount SAGIC:

Contents with Alarm Discount MIRAMAR Level 1:

Contents with Alarm Discount MIRAMAR Level 3:

Increased Excesses Discount SAGIC:

Increased Excesses Discount MIRAMAR Level 1:

Increased Excesses Discount MIRAMAR Level 3:

Contents Premium Excl. IPT SAGIC:

Contents Premium Excl. IPT MIRAMAR Level 1:

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Buildings and Contents Premium SAGIC:

Buildings and Contents Premium MIRAMAR Level 1:

Buildings and Contents Premium MIRAMAR Level 3:

Please select the tenant type from the list. If the tenant type is unavailable please call us:

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Subtotal with Resident Type Added SAGIC:

Subtotal with Resident Type Added MIRAMAR Level 1:

Subtotal with Resident Type Added MIRAMAR Level 3:

What area of the roof is flat:

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Subtotal with Flat Roof Added SAGIC:

Subtotal with Flat Roof Added MIRAMAR Level 1:

Subtotal with Flat Roof Added MIRAMAR Level 3:

If the property is a block of flats what percentage is unoccupied:

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Subtotal with Block of flats Added SAGIC:

Subtotal with Block of flats Added MIRAMAR Level 1:

Subtotal with Block of flats Added MIRAMAR Level 3:

What is the age of the main proposer:

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Subtotal with Age Discount Added SAGIC:

Subtotal with Age Discount Added MIRAMAR Level 1:

Subtotal with Age Discount Added MIRAMAR Level 3:

How long have you owned the property without a claim:

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TOTAL PREMIUM BEFORE TAX SAGIC:

TOTAL PREMIUM BEFORE TAX MIRAMAR Level 1:

TOTAL PREMIUM BEFORE TAX MIRAMAR Level 3:

Total Premium Before Tax (Referal Loading -10%) SAGIC:

Total Premium Before Tax (Referal Loading -10%) MIRAMAR:

Total Premium Before Tax (Referal Loading -10%) MIRAMAR Level 3:

IPT (12%) SAGIC:

IPT (12%) MIRAMAR Level 1:

IPT (12%) MIRAMAR Level 3:

Subtotal Before £35 Brokers Fee SAGIC:

Subtotal Before £35 Brokers Fee MIRAMAR Level 1:

Subtotal Before £35 Brokers Fee MIRAMAR Level 3:

Please check all relevant boxes

You have not been declined building or property insurance or had a policy cancelled, withdrawn or offered on increased terms:

You have not been convicted or have a prosecution pending for a criminal offence (other than a minor motor offence):

You have not been declared bankrupt or have not satisfied County Court judgement:

You have not made a claim against a building or property in the past 3 years:

All insured are 18 years old or over:

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Property is not in a flood area nor suffered from flood damage in the past 10 years:

The property is an area free from subsidence, heave and landslip and has not suffered from subsidence or been underpinned:

The property has either, stone, brick or concrete walls:

The property has a roof of tiles, concrete or slate:

The property is in a good state of repair or currently undergoing renovation:

The property was not built before 1850 and is not listed:

There are no trees more than 5 metres tall within 5 metres of the property:

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Landlord and Unoccupied Property Insurance Calculator

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