.:Oliver Wright Personal Financial Planning, New Ollerton:.

Date cover is required from:

	Proposer	Joint Proposer
Name
Email address
Telephone
Address
Date of Birth
Occupation/Job
Business type/Industry
Address of property to let
Is the property for private or business use?
If the property is to be used for business, of what nature?
Property type
Is the building of standard construction?	Yes No
If no, please suppy further details
Year built
No. of bedrooms
Type of tenant
Buildings sum to be insured
Landlords contents sum to be insured (if required)
If business, rent per annum
Period of indemnity
Have you made any claims in the past 5 years?	Yes No
If yes, please include details
Please add any further relevant points to ensure we provide an accurate quote for you.

'Authorised and regulated by the Financial Services Authority'
Firm reference no : 300051