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Home > Belle Isle TMO Services > Home insurance application form

Home insurance application form

Leeds City Council Tenants and leaseholders now have the chance to insure the contents of their homes in an easy and affordable way.

We are pleased to tell you that Leeds City
Council have negotiated a scheme with Royal & Sun Alliance Insurance plc, one of the UK’s leading insurers.

Tenants Contents Insurance

Title

Full name of applicant

Please list all joint tenants, leaseholders and co-habitees

Address of your home to be insured

Tenancy No.

Date of birth

Telephone No.

Precise occupation

Cover to start on

Whenever we ask questions in this application about your household, we mean You and Your family (including your partner and all children) who normally reside with you.

Please tick / select if any member of your household who normally reside with you at your current address or elsewhere:

Made a claim to any insurer in the last five years in respect of household contents insurance?

Suffered any loss or damage while not insured but which would have resulted in a claim if a household contents policy had been in force at the time?

Been refused any insurance or had special terms or conditions applied or cover cancelled by insurer?

Been convicted of any offence other than parking or speeding offences or offences which are spent under the Rehabilitation of Offenders Act 1974?

Had insurance under the Council's scheme canceclled?

If you have ticked any of the above questions, give full details (including dates and loss amounts) in the Additional Information box below.

Additional Information

Amount to be insured
It is important that the sum chosen is sufficient to replace ALL your household goods and personal belongings. If the sum insured is inadequate you will have to bear a rateable proportion of any claim.

(To the nearest £1000)

Important
Please read the following carefully before you sign and date the Declaration.

Claims and Underwriting Exchange - Insurers pass information to the Claims and Underwriting Exchange register, run by Insurance Database Services Ltd (IDS Ltd). The aim is to help us to check information provided and also to prevent fraudulent claims. When we deal with your request for insurance, we may search the register. When you tell us about an incident (such as fire, water damage or theft) which may or may not give rise to a claim, we will pass information relating to it to the register

You can ask us for more information about this.

You should show this notice to anyone who has an interest in property insured under the policy.
All personal information supplied by you will be treated in confidence by the Royal & Sun Alliance Insurance Group of companies and will not be disclosed to any third parties except where your consent has been received or where permitted by law. In order to provide you with products and services this information will be held in the data systems of the Royal & Sun Alliance Insurance Group of companies or our agents or subcontractors.

The Royal & Sun Alliance Insurance Group of companies may pass your personal data to other companies for processing on it’s behalf. Some of these companies may be based outside Europe in countries which may not have laws to protect your personal data, but in all cases the Group will ensure that it is kept securely and only used for the purposes for which you provided it. Details of the companies and countries involved can be provided to you on request.

Declaration
Important Note: Before you sign this form, please read it again making sure all questions are answered in full. Check that the answers which have been given are correct. Once you and any joint applicant sign this form you are responsible for its accuracy. To give false information knowingly in answer to any of the questions in order to obtain insurance or to obtain a reduced premium could be a criminal offence and will certainly invalidate your insurance.

I/We declare that to the best of my/our knowledge and belief, the statements made by me/us or on my/our behalf are true and complete.
I/We understand that you will pass the information on this form and about any incident I/we may give details of to IDS Ltd so that they can make it available to other insurers. I/We also understand that, in response to any searches you may make in connection with this application or any incident I/we have given details of, IDS Ltd may pass you information it has received from other insurers about other incidents involving anyone insured under the policy.

Tick to accept the above declaration

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