HOW TO APPLY FOR A QUOTATION
Each case will be individually considered 
There will be in some cases where we will be unable to offer cover

You can  a) complete the form below and click on the submit button.
               b) print this page, complete and post to us.
               c) print this page, complete and fax to us.
               d) telephone us with your details
                  (if you wish we will post you a form.)

 


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Fairplay Home Insurance Services Ltd
Charter House, 
43 St Leonards Road,
Bexhill-on-sea,
East Sussex,
TN40 1BR

 

 
Tel : 01424 220110
Fax : 01424 217107

Email: cover@bureauinsure.co.uk


Title:   Name:
Address:
Town : County:
Post Code:   Tel No:

                       Buildings Insurance : (full re-building cost)

                         Contents Insurance: (full replacement cost as new)
All Risks:

   

                 Marital Status:      Date of birth :

Is your home: Rented    Owned    Other -
Your Previous Insurer:
Your previous 
claim history:
Occupation :
Spouse's Occupation :
Have you or anyone residing with you, been refused insurance or had any special terms or restrictions imposed at this or any previous home?
Please give details.


If you have convictions 
Please use this space to detail them including date, offence, circumstance, sentence. (please include details of custodial and community sentences)


(Please Tick)      Please will you quote me based on the details above
                         The information given is correct and true.