TIS: House Insurance - On-line Application/Quotation Form

Full Name
NIE Nº.
Email
Tel./Mob. Number(s)
Address
Post Code
Year Built
Year Refurbished
Size in sq meters of house (all floors)
Size in sq meters of patio/terrace & pool
Cover Required

Cover Required Buildings & Contents Contents Only Buildings Only All Options
Type of Property

Type of Property Finca Detached Terrace / Town House Apartment (ground floor) Apartment (middle floor) Apartment (top floor)
Type of Contruction

Type of Contruction Normal Bricks & Mortor With Wood ( more than 15% )
Use of Property

Use of Property Owned - Habitual Residence Owned - Second Property Owned - Rented out, long term 12mths+ Rented - Habitual Residence Owned - Rented out, short term less 12mths (vacacional)
No of consecutive days empty

No of consecutive days empty LESS than 30 days 31 - 180 days 180+ days Weekend Use only
Security Measures

Security Measures Front Door - Security Front Door - Solid wood or Glass Multi-lever locks Bars on ALL windows Shutters on ALL windows/access points Alarm - connected to central system Alarm - NOT connected to central system Anti-robbery Glass (6mm + 6mm) Safe (concreted in with 2 keys, 2 combination locks or 1 of each) Safe - weighs more than 100 Kilos None of the above.
Other Liberty policy numbers

FOR EXTRA DISCOUNT : Specify other Liberty policy numbers
Specified items of jewellery & Value

Please give details of individual items worth more than 2,000€
Value of Contents

Value of Contents 6,000 Min 12,500 20,000 30,000 Other Other

Minimum value 6,000. Includes kitchen units
Public Liability
(Automatically included on all policies)

Public Liability
(Automatically included on all policies) 300,000 450,000 600,000 1,000,000
Other Options ...

Other Options ... Accidental Damage to contents (30,000€ min) Accidental Damage to Buildings (60,000€ min) Vehicle in gargae Dangerous Dogs (approx. 30€)
IBAN CODE : 24 Characters.
e.g. ES07 1234-1234-1234-1234-1234

Policy MUST be paid by Direct Debit to qualify for CashBack and other offers.
Any Comments, Questions or Suggestions :
Required Start Date of Policy
(can be date of application) Required Start Date of Policy
(can be date of application) / DD / MM YYYY
Data Protection/Ley de Protección de Datos

Data Protection/Ley de Protección de Datos I agree to the sending and retention of this personal data in compliance with The Data Protection Act. / Estoy de acuerdo con el envío y la retención de estos datos personales de acuerdo con la Ley de Protección de Datos.
Type the letters you see in the image below.