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THE COMPTON GROUP Powered By Docstoc
					                                                            THE COMPTON GROUP
                               (Compton Developments Ltd - Tapestart Ltd – Helpfavour Ltd – Gracefavour Ltd)
                                           Proposal Form for Residential Property Insurance
                        (This form is also acceptable for offices, shops and small commercial properties)
                                       Please complete this form in BLOCK LETTERS.
N.B. All sections of the proposal must be completed before the premium and cover available can be confirmed. Please tick the
appropriate boxes and give a definite answer to each question. Cover will not apply until the proposer(s) has received
confirmation that this application form has been accepted.

                 Date from which cover is required                                                               How do you wish to pay
                                                                                                              Annually or Monthly Instalments
                         /                            /                                                Annually                      Monthly
The Insurance will be annually renewable on the date specified in the policy schedule            Please tick the box

                             Proposers Full Names                                                                        Dates of Birth
Mr/Mrs/Miss/Ms                                                                                  (1)
Mr/Mrs/Miss/Ms                                                                                  (2)

                                                    Proposers Postal Address – for correspondence

                                                                                                Post Code

                 Proposers Occupations/Professions                                                                Daytime telephone numbers
(1)                                                                                             (1)
(2)                                                                                             (2)
Unless the nature of the trade or business in which you work is clear from
the job description, please specify

                                                                    Properties to be insured
                    Please give full details of each property to be insured. If insufficient space please continue on a sheet of paper
Property Address (if different from the postal address above)

                                                                                                   Post Code

Approximate year property was built:

Type of Property          Bungalow                 House                Maisonette               Purpose Built Flat            Conversion Flat

Is the Property:          Detached                 Semi-detached                        Mid-Terrace               End of Terrace

Declared Value: £__________________ (N.B. An amount must be specified; “unlimited” cover is not available.)
N.B. The Declared Value should represent the cost of reinstatement of the property (including garages and outbuildings) to be
Insured at the level of costs applying at the start of the Insurance period plus an allowance for:
a) additional cost of reinstatement to comply with
      I. European Union Legislation
     II. Act of Parliament
    III. Bye-Laws of any public authority
b) professional fees
c) debris removal costs
To the above figure an automatic 50% will be added to allow for inflationary trends during the period of Insurance together with
the period required to reinstate the property to be Insured.

(This amount will be automatically index linked by Aviva each year in line with changes in the House Rebuilding Index issued by the RICS).

If you are unsure how to access this figure you can use the Association of British Insurers/BCIS on-line house rebuilding cost calculator at or you can contact Compton Insurance Services Ltd on 01792 315465/4/3 to discuss your requirements. In addition your
mortgage lender (if applicable) may wish to specify a minimum amount for insurance as security for their loan, and we recommend that you
check this with them.

If you do not require Accidental Damage cover please tick here

NB* Please also complete next page of proposal form
Ownership – is the property:

Owned on a                  Owned                 Rented from                     Rented from                       Other**
mortgage                    outright              Local Authority                 Private Landlord

**please specify details
Do you require the name of any interested party to be noted in your policy e.g. Mortgagee?                  Yes                   No
If Yes, please give the name and address:

Tenanted Property – please complete this section if the property to be insures is let out to tenants
1. How many tenants occupy the property?
2. Length of tenancy agreement?
3. Is the tenancy agreement under the control of a management company?
4. If you manage the tenancy yourself, are references taken?
5. Is the property let to any person(s) not subject to an Assured Shorthold Tenancy Agreement?
If Yes, please describe the type of tenancy agreement in place
6. Is any part of the property let to students, asylum seekers or DSS recipients?
If you have answered „YES‟ to Questions 3-6, please give full details on the attached sheet.

                            General Information – to be completed by ALL PROPOSERS
                                                                                             (Please tick the box)                       YES    NO
1. Does the Declared Value represent the cost of reinstatement as described above?
2. Is the property constructed of brick, stone or concrete and roofed with slates, tiles, asphalt, concrete or metal?
3. Is the property (a) in a good state of repair?
                   (b) will it be so maintained at all times?
4. Is the property occupied by you, your domestic partner and family members only, as a private dwelling?
5. Is the property your permanent residence (i.e. not used as a weekend, weekday or holiday home only)?

      If you have answered „NO‟ to any of the Questions 1-5, please give full details on the attached sheet.
6. Is the property or any part of the property occupied or used for any trade or business purposes?
7. Is there any area of flat felt roof on timber boarding at the property which exceeds 50% of the total roof area?
8. Does the property have any increased exposure to damage by storm or flood?
9. Does the property have any sign of damage by subsidence, heave or landslip?
10.Are you aware of any previous damage to the property of any other properties in the near neighbourhood by
   subsidence, heave or landslip?
11.Is the property currently unoccupied?
12.Is the property likely to be unoccupied for more than 60 consecutive days at any time in the future?
13.Is the property undergoing (or likely to be undergoing) any refurbishment or building work?
14.Have you or any person to be insured suffered any loss, damage, injury or liability in the last 3 years (whether
   insured or not) from any of the events to be insured by this policy?
   If ‘yes’ please provide full details of date, type of claim (e.g. theft, fire, flood etc) and the amount of the claim.
Claim Details:
Date               Type of Claim (i.e.Theft/Fire/Flood)                                                                            Amount Claimed
__________          _______________________________________________________________________                                        ______________
__________          _______________________________________________________________________                                        ______________
__________          _______________________________________________________________________                                        ______________
__________          _______________________________________________________________________                                        ______________
__________          _______________________________________________________________________                                        ______________

15 Have you or any person to be insured:
   a) ever had a proposal for insurance declined, renewal refused, cover terminated, increased premium
       required or special conditions imposed by any insurer?
   b) ever been convicted of, or cautioned for (or charged but not yet tried with) any criminal offence (other
       than motoring offences)?
   c) ever been declared bankrupt or insolvent or been disqualified from being a company director
       ever been the subject of County Court Judgements, Individual Voluntary Agreements, Company
       Voluntary Agreements or Sheriff Court Decrees

       If you have answered „YES any of the Questions 6-15, please give full details on the attached sheet.

In the spaces provided below please indicate the name(s) of your present Insurers for:
a. Buildings _________________________________________ b. Contents _______________________________________________
                       Aviva reserve the right to contact your present/previous Insurers for further details of your insurance history
                                              OPTIONAL COVERS
 We are able to offer you the facility of a Contents insurance scheme alongside the Buildings cover. The scheme
 provides for contents cover of £40,000 with the option to upgrade to include accidental damage and /or cover for
your personal belongings away from the home. If you wish to add Contents insurance please complete the section

Do you require Contents with a Sum insured of £40,000?                                                           Yes/No
If Contents Cover is selected do you wish to:-
A)    upgrade to Accidental Damage Cover                                                                        Yes/No
B)    include cover for Personal Belongings away from home                                                      Yes/No
      (no single item to exceed £2,500)
If yes please select the sum insured required:
£1,000                   £2,000                   £3,000                    £4,000                £5,000                    £6,000                  £7,500

                                                        Additional Information Sheet
 Section / Question          Additional Information

                                                     You must sign the declaration below
                        This declaration also applies to any „Optional Covers‟ you have opted to include in the policy

PLEASE NOTE: No advice has been given as to the suitability of this product. Aviva do recommend that you read the material that will be sent to you with
your quotation to confirm that this product matches the demands and needs of those wishing to protect the structure of the property to be insured and its
contents (if this option is selected) against loss or damage by specified causes, and for family legal protection and assistance (if this option is selected) to
provide legal support as defined in the policy. There is the possibility that other taxes and/or costs may exist that are not paid via The Compton Group or
imposed by them.

Please read carefully the note at the beginning of this proposal and this declaration before signing
You understand the contents of this application and You declare that
the information given is, to the best of Your knowledge and belief
correct and complete. You agree that any statements in this                      Signature(s) ………………………………………………………
application shall form the basis of the contract between You and the
Aviva and if the risk is accepted You undertake to pay the premium
when called upon to do so. You understand that your information                  Position if signing
may also be disclosed to regulatory bodies for the purposes of                   For firm or Company……………………………………………..
monitoring and/or enforcing our compliance with any regulatory
NB The insurance cover will not be effective until this proposal                 Date ………………………………………………………..………
     has been received and accepted by the Insurance
     Company underwriter.
                                                                             IMPORTANT INFORMATION
Choice of Law
The appropriate law as set out below will apply unless you and Aviva agree otherwise:
1.) The law applying in that part of the UK, Channel Islands or Isle of Man in which you normally live or (If Applicable) the first named policyholder normally lives; or
2.) In the case of a business, the law applying in that part of the UK, Channel Islands or Isle of Man where it has its principal place of business; or
3.) Should neither of the above be applicable, the law of England and Wales will apply.

If You Have a Complaint
Aviva hope that you will be very happy with the service that is provided. However, if for any reason you are unhappy with it, Aviva would like to hear from you. In the first instance,
please write to your insurance advisers.

Your insurance advisers and Aviva Insurance Limited are covered by the Financial Ombudsman Service. If you have complained to Aviva and they have been unable to resolve your
complaint, you may be entitled to refer it to this independent body. Following the complaints procedure does not affect your right to take legal action.

Telephone Call Recording
For our joint protection telephone calls may be recorded and/or monitored

Material Facts
Please remember that you must inform Aviva of any circumstances of which Aviva may not be aware. Failure to do so could invalidate the policy. If you are in any doubt as to whether
a fact is material it should be disclosed to Aviva. If there have been any changes in circumstances that have arisen since this insurance was taken out or last renewed please inform your
insurance advisers.

This new business/renewal invitation is made on the basis of the information we have at the time it is issued. Aviva may revise or withdraw it if, after the inception of your policy or
before the date your renewal takes effect, any event occurs that alters the material facts or gives rise to a claim under this insurance, even if Aviva are notified after your policy’s
inception date /renewal date.

You should keep a record (including copies of letters) of all information supplied to Aviva for the purposes of the renewal of this insurance.

For the purposes of the Data Protection Act 1998, the Data Controllers in relation to any personal data you supply are your insurance adviser and Aviva Insurance Limited.

Insurance Administration
Your information may be used for the purposes of insurance administration by Aviva, its associated companies and agents by reinsurers and your intermediary. It may be disclosed to
regulatory bodies for the purposes of monitoring and/or enforcing Aviva’s compliance with any regulatory rules/codes. Your information may also be used for offering renewal,
research and statistical purposes and crime prevention. It may be transferred to any country, including countries outside the European Economic Area for any of these purposes and for
systems administration. Where this happens, Aviva will ensure that anyone to whom we pass your information agrees to treat your information with the same level of protection as if
Aviva were dealing with it. If you give Aviva information about another person, in doing so you confirm that they have given you permission to provide it to Aviva to be able to process
their personal data (including any sensitive personal data) and also that you have told them who Aviva is and what they will use their data for, as set out in this notice.

In the case of personal data, with limited exceptions, and on payment of the appropriate fee, you have the right to access and if necessary rectify information held about you.

In assessing any claims made, Aviva or its agents may undertake checks against publicly available information (such as electoral roll, county court judgements, bankruptcy orders or

Information may also be shared with other insurers either directly or via those acting for Aviva (such as loss adjusters or investigators).

Credit Searches and Accounting
In assessing your New Business enquiry or Renewal, to prevent fraud, check your identity and to maintain its policy records, your insurance advisers or Aviva may search files made
available to it by credit reference agencies who may keep a record of that search. Your insurance advisers or Aviva may also pass to credit reference agencies information it holds about
you and your payment record. The information will be used by other credit lenders for making credit decisions about you and the people with whom you are financially associated for
fraud prevention, money laundering prevention and for tracing debtors.

Your insurance advisers or Aviva may ask credit reference agencies to provide a credit scoring computation. Credit scoring uses a number of factors to work out risks involved in any
application. A score is given to each factor and a total score obtained. Where automatic credit scoring computations are used by Your insurance advisers or Aviva, acceptance or
rejection of your application will not depend only on the results of the credit scoring process.

Sensitive Data
In order to assess the terms of the insurance contract or administer claims that arise, Aviva may need to collect data that the Data Protection Act defines as sensitive (such as medical
history or criminal convictions). By proceeding with this new business enquiry/renewal you will signify your consent to such information being processed by Aviva or its agents.

Fraud Prevention and Detection
In order to prevent and detect fraud we may at any time:

     Share information about you with other organisations and public bodies including the Police;
     Undertake credit searches and additional fraud searches;
     Check and/or file your details with fraud prevention agencies and databases, and if you give us false or inaccurate information and we suspect fraud, we will record this.

We can supply on request further details of the databases we access or contribute to

We and other organisations may also search these agencies and databases to:

     Help make decisions about the provision and administration of insurance, credit and related services for you and members of your household;
     Trace debtors or beneficiaries, recover debt, prevent fraud and to manage your accounts or insurance policies;
     Check your identity to prevent money laundering, unless you furnish us with other satisfactory proof of identity.

Claims History
    Under the conditions of your policy you must tell your insurance advisers and Aviva about any Insurance related incidents (such as fire, water damage, theft or an accident)
     whether or not they give rise to a claim. When you tell us about an incident we will pass information relating to it to a database.
    We may search these databases when you apply for insurance, in the event of any incident or claim, or at time of renewal to validate your claims history or that of any other person
     or property likely to be involved in the policy or claim.
You should show these notices to anyone who has an interest in the insurance under the policy.

Period of Validity of Quotations
The renewal premium quoted is valid until the expiry of your current policy.

                                                                                       Underwritten by

                                                                                 Aviva Insurance Limited
                                                     Registered in Scotland, No. 2116. Registered Office: Pitheavlis, Perth PH2 0NH.
                                                              Authorised and regulated by the Financial Services Authority.

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