autopopulate(e.detail)"> Thank you for your enquiry, we will be in touch shortly.As a leading independent insurance broker and specialist in insurance, risk management, and financial planning products, we are dedicated to finding the right cover to suit your needs.We’d love to hear about your experience with us so far! Please take a moment to rate us on Google. Leave a review 1 2 3 Page 1 of 3 : Your details Your details Proposer name Contact telephone number Email address Date of birth Page 2 of 3 : Property details Property details Find your address Search with your postcode or first line of the address Enter address manuallyAddress line 1Address line 2Address line 3TownPostcodeAutocomplete addressThere is a problem with the address you have entered. Please check the address for errors. Property type Please select...Detached houseSemi-detached houseTerracedFlat / MaisonetteBungalow Year of build No. of bedrooms What are the walls constructed of? (bricks, timber etc) What is the roof constructed of? (tiles, felt, thatched etc) Page 3 of 3 : Cover Cover When do you wish cover to start? Do you require building insurance? Yes No Do you require accidental damage cover? Yes No Do you require contents insurance? Yes No Claims If applicable, please provide details of any claims you or any insured has made in relation to this or other properties in the last five years (date, amount claimed, type of claim etc) Declarations By clicking submit you agree the following:Neither I or anyone living at the property have ever been convicted of or charged (but not yet tried) or been given an official police caution in connection with any other criminal offence other than parking or speeding offences or offences which are spent under the Rehabilitation of Offenders Act 1974.Neither I or anyone living at the property have ever had a proposal for or a renewal of insurance refused, had a policy cancelled or declined, or had special terms and conditions imposed by any Insurer.Neither I or anyone living at the property have ever been the subject of a County Court Judgement or Sheriff Court DecreeNeither I or anyone living at the property have ever been declared bankrupt or insolvent or been disqualified from being a company director, or been involved as owner, director or partner with any company which went into receivership, administration or liquidation. Agent Char4 XStream Office Branch XStream Customer Classification XStream Client Type XStream Exec Code XStream Agent Code XStream Insurance Company XStream Policy Type XStream Commercial Type XStream Feed Name XStream Occupation XStream Source XStream Source Extra There was a problem with some of the information you entered. Please check the form for errors and try again. A technical error occurred when trying to submit this form. Please call us to let us know. Previous Continue Submit