Glennon/IWA Home
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IWA Enquiry Forms
Car Insurance
Family Home Insurance
Investment Property Insurance
Holiday Home Insurance
Main Residence Enquiry Form
Personal Details
Name
This is a required field
Date of Birth
This is a required field
Occupation
This is a required field
Contact Details
Postal Address
This is a required field
Home Phone Number
Work Phone Number
Mobile Phone Number
Please provide at least one phone number
Email Address
Please enter a valid email
Address of the property
to be insured
(if different)
This is a required field
Details of Property to be Insured
Type of Property
Please Select...
Detached House
Semi-Detached House
Terraced House
Bungalow
Duplex
Purpose-Built Apartment
Flat
Please select a type of property
Approximate Size of the Property
Please note the approximate size of the property, in either Sq. Ft. or metres square
Value of Buildings
Please include the value of the buildings to be insured
Value of Contents
Please include the value of contents to be insured
Do you wish to cover items on an 'All Risks' basis?
Yes
No
All Risks Cover — Unspecified Items
Value of Miscellaneous Valuables, Personal Effects and Sports Equipment
This is a required field
All Risks Cover — Specified Items
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Discount-Related Questions
Do you have a minimum of two smoke detectors?
Yes
No
Do you have a burglar alarm?
Yes
No
Is the alarm subject to a maintenance contract?
Yes
No
Is the alarm connected to a central monitoring station?
Yes
No
Are all external doors fitted with 5-lever mortice deadlocks or their equivalent and are all accessible windows fitted with key operated window locks?
Yes
No
Are you in a Garda approved Neighbourhood Watch or Community Alert Scheme?
Yes
No
If you have a Car Insurance policy, who is the Insurer?
This is a required field
How many bedrooms are there in your home?
This is a required field
Declaration
I declare that my home is
built of brick, stone or concrete and is roofed with slates, tiles, metal, concrete or asphalt
in good repair and will be so maintained
my principle residence in my sole occupation and not used for business or professional purposes or for keeping paying guests.
not especially exposed to damage from storm, flood, subsidence, landslip, falling trees or vandalism
not left unoccupied for more than 30 consecutive days in any one year
not more than 100 years old.
You must make this declaration.
I declare that neither I nor any member of my family normally residing with me have
had any Insurer decline a proposal, refuse to renew or cancel a policy, or impose special terms or conditions
sustained any loss, damage, or incurred any liability to third parties during the past 5 years in relation to the cover now being sought for this or any other property.
If the above declaration is not correct, you must provide details of exceptions
If the above Declarations are not correct in every detail please provide details below:
If the above declarations are not correct, you must provide details of exceptions
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