Household Comprehensive Proposal Form Personal DetailsName* Postal Address*Full Address of dwelling to be insuredTelephone* Email* Occupation status*---EmployedSelf-employedHousehold dutiesUnemployedStudentIdentity Card NoI/ Company Reg. No./ ARC* Present Insurer Period of insuranceFrom:* DD slash MM slash YYYY To:* DD slash MM slash YYYY Cover Required Building Contents Liability to Third Parties and Servants All Risks Property DetailsType of Dwelling*SelectDetachedSemi-DetachedFlatYear Dwelling Build* Option 1 Is the dwelling build of bricks and concrete? Option 2 Is there a basement and/or storeroom at the insures premises? Option 3 Have you ever suffered loss from the event you wish to insure? If yes, please give detailsOption 4 Is there a safety system installed to protect against burglary? If yes, please give detailsBuildings and ContentsBuilding (Sum Insured) Option 1 Would you like Reinstatement value-based Insurance? Option 2 Is there a swimming pool in your dwelling? Option 3 Is there any other person having financial interest in the property; If yes, please give detailsOption 4 The cover provided by this Section includes Indemnity to the owner against his liability to the public with the Limit of Indemnity of 20.000,00 € - At an additional premium, the Limit of Indemnity can be increased to 100.000,00 €. Do you require the increased cover? Contents (Sum Insured) Option 1 Would you like Reinstatement value-based Insurance? Option 2 Do you wish to extend the Policy to cover Theft whether accompanied by forcible or violent entry or not? Option 3 Does the value of articles of precious metal, or other precious articles such as jewellery, furs, carpets, paintings or other works of art etc. exceed one-third of the Sum Insured on contents? If yes, please give details Please give details of any article or any collection of articles, which exceeds 5% of the Sum Insured on Contents? Extensions for Buildings and Contents Earthquake or Volcanic Eruption Bursting or overflowing of a water tank,apparatus or pipe Deep freezer contents Sum Insured Money Limit up to €500 Sum Insured Equipment on the roof for Hurricane, Cyclone, Tornado or Storm, Tempest and Flood Limit up to €2.000 Sum Insured Investigation Cost caused by the Bursting of Pipes (Limit up to €1.000) Sum Insured Cost of water escaped caused by the Bursting of Pipes (Limit up to €500) Sum Insured Furniture in the open for Hurricane, Cyclone, Tornado or Storm, Tempest and Flood (Limit up to €500) Sum Insured Furniture in the open for Theft ,please declare for amount Sum Insured Liability to Servants and All RisksPlease Specify whether you wish cover for the following risksLiability to Third Parties and Servants. Limit of Indemnity €100.000 All Risks Available only if contents are insured and only for specific items If yes, Please list on the space provided, full descriptions and values.Evidence of the value is required.For Data Protection Company Policy Click Here. * I have read the Data Protection Company Policy posted on this website I herewith provide Royal Insurance Company Ltd (and any successors and assignees thereof), my express and unconditional consent regarding the processing and creation of data records in electronic and physical form, of all my relevant personal data, that may include sensitive data which I have declared and submitted PhoneThis field is for validation purposes and should be left unchanged.
