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Draft-Flood-Insurance-Questionnaire by hedongchenchen


									National Flood Forum Ireland - Flood Insurance Questionnaire
Objective: To Provide our Government and Public Agencies with accurate Data regarding Insurance
               of properties in areas that used to flood/still flood
Completed forms to be sent to

Address of Property being discussed in this Survey (a separate form for each property)

Town/City                                                    County
GPS Co-Ordinates
(if easily available)                             Home       Business Both          Please tick appropriate box
If Business - what type of Business

Has Your Property Flooded in the Past? Yes/No
If Yes please give description including frequency, where water came in exactly, garden, basement, street
 etc. etc.

Depth - please indicate whether using
Feet/Inches or M/CM/MM
If Flooded what was the main reason for the Flooding in your area:
                  Heavy Rainfall      River/Watercourse   Coastal   Drains (manmade) Don't know
                     Flood Defence breach           Groundwater    Other please specify

If Flooded what damage was sustained?
 Please describe losses, power failure
   unable to drink the water, illness etc.

Did you Claim on Your Insurance as a result? Yes/No

If you have not flooded have you ever been advised
that your property may be at risk of flooding? Yes/No

If Yes who advised you?               Flood Maps                Nearly Flooded in the Past     Other (please specify)
              Insurance Company Local Knowledge                 Historical Maps

If Yes do you believe this? Yes/No

If No why?                    Never Happened Before          Long Way from River      Flood Relief Scheme in place
                         Other (please specify)

Is your property protected by a Publicly Funded Flood Relief Scheme? Yes/No/Don'tKnow
 (i.e. Walls, Embankments, Attenuation Pond)
If Yes please give brief description

Is your property protected by Private Flood Protection Works? Yes/No
 (i.e. Flood Gate, Stop Logs, Purposely
    elevated floor levels)
If Yes please give brief description
Who Commissioned the Works?
             You        Neighbourhood Scheme                                    Previous Resident             Other       Don't Know

Are the Protection Works
                                                Permanently in place                            Put in place when in danger of flooding

Are there plans for a National Flood Relief Scheme in your area?                                 Yes            No        Don't Know
If Yes please give brief description

Are there plans for Private Relief Works in your area?                            Yes            No        Don't Know
If Yes please give brief description

Do you currently have building/contents Insurance?
                  Yes        Building Only       Contents Only                                  Both            No
If Yes please give name of Insurance Provider/Underwriter

If Yes does your insurance cover Flooding?                          Yes            No       Don't know
If Not covered when did you last have Flooding Cover

Why are you now NOT covered for flooding?
              Premium too high     Insurance refused                            Policy offered without Flood Cover
             Other please specify:

If your policy does include Flood cover, what is the excess                                                Don't know
Has this increased in recent years?                                                              Yes          No      Don't Know

If you benefit from Flood Protection Works has any of the following happened since completion?
                   Not told Insurance Co about the Works       Told the Insurance Company about the works
                      Now able to get Flood Insurance                      Premium has reduced
                           Premium has increased                            Excess has reduced
                            Excess has increased                                No Change
                Any other Comments:

Include me on National Flood Forum Database                                     Yes              No        Please tick appropriate box
Contact No.            Landline:                                              Mobile:

Please email to

In Strict Confidence - Information given herein will remain confidential and in accordance with the Data Protection Act
Those opting to be on the National Flood Forum Database will be contacted regarding Flooding issues
only - no third party will be given access to your information

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