TIS: Community Insurance - On-line Quotation Form

Full Name of Community
CIF Nº
Name of Person to be contacted
Tel./Mob. Number(s)
Email
Community Address
Post Code
Type of Construction
Quality of Construction
Year Built
If building is 50+ yrs old - Year plumbing was replumbed
Type of Property

Type of Property Apts. building(s) WITH shops/office Apts. building(s) WITHOUT shops/office Separate houses WITH shops/office Separate houses WITHOUT shops/office
Nº of Buildings/Blocks
Nº of Floors
Nº of Apts and/or Offices
Size in sq meters of Apts and/or Offices
Nº of Floors/Levels in Garage
Nº of Car Parking Spaces in Garage
Size in sq meters of Car Parking Spaces
Nº of Commercial Premises
Size in sq meters of Commercial Premises
Size in sq meters of rest of Community Area
Security Measures
Increase cover for objects of value ?
Other Liberty policy numbers

FOR EXTRA DISCOUNT : Specify your other Liberty policy numbers
Public Liability

Public Liability 300,000 450,000 600,000 1,000,000
Additional Policy Options ...
Recovery of Community Charges
Breakage of Glass
Water Damage
Public Liability - Type of cover
Public Liability - Amount of cover
Breakdown of Machinery
(must have maintenance contract )
Employee Dishonesty - Amount

12,500€ max, Claim has 20% excess
Accident Cover
No of Employees

Enter 0 if not required.
Accident -
Value for Death (€)

Enter 0 if not required.
Accidents -
Value for Disability (€)

Enter 0 if not required.
Policy Excess Options ...
Glass
Water Damage
Pub. Liab. - Water damage
Policy Start Date Policy Start Date / DD / MM YYYY
IBAN CODE : 24 Characters.
ESxx , plus Bank Account Nº ( 20 Digits 4-4-2-10 )

Policy MUST be paid by Direct Debit to qualify for CashBack and other offers.
Any Comments, Questions or Suggestions :
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.

TIS: Community Insurance - On-line Quotation Form

TIS: Community Insurance - On-line Quotation Form

Additional Policy Options ...

Policy Excess Options ...