Mudeford Chalet Quotation Request Form

Mudeford Chalet Quotation Request Form

Date cover required from / Your Renewal Date: Click here to enter a date.

How did you hear of Love Your Hut? ☐ Web ☐ Recommend ☐ Association ☐ Other

Your Details:

Title: / ☐ Mr ☐ Mrs ☐ Miss ☐ Other / Click here to enter text. /
First Name: / Click here to enter text. / Surname: / Click here to enter text. /
Home Address: / Click here to enter text. / Tel (home): / Click here to enter text. /
Click here to enter text. / Mobile: / Click here to enter text. /
Click here to enter text. / Email: / Click here to enter text. /
Click here to enter text. / Occupation: / Click here to enter text. /
Postcode: / Click here to enter text. /

Yes No

Have you ever had insurance cancelled / refused or terms imposed?☐☐

Have you any unspent convictions (non-motoring) under the Rehabilitation☐☐

of Offenders Act 1974?

Have you ever been declared bankrupt / IVA/Debt relief order / CCJ’s?☐☐

Have you had any insurance claims in the last 5 years?☐☐

If you have answered Yes to any of the above, please give details below:

Details of Your Chalet

Chalet Name: / Click here to enter text. /
Chalet Address: / Click here to enter text. /
Chalet Location: / ☐ Beach ☐ Dune ☐ Other / Click here to enter text. /
Chalet Construction: / ☐ Wood ☐ Concrete ☐ Asbestos ☐ Other / Click here to enter text. /
Do you use your chalet for business? ☐ Yes ☐ No
If yes, what for: / Click here to enter text. /
Boat Cover – do you need any boats covering at the chalet? ☐ Yes ☐ No
If Yes, value of each boat: / £Click here to enter text.
Previous Insurer: / ☐ Wood ☐ Concrete ☐ Asbestos ☐ Other / Click here to enter text. /
Sums Insured
Buildings / £Click here to enter text.
Contents / £Click here to enter text.

We will hold the details you have provided to process your quote and may, from time to time, contact you with carefully selected information about our products and services and those of our group. If you prefer not to receive marketing information please tick the box. ☐

Web – Email – Tel – 0333 207 5644

Love Your Hut is a trading name of Precision Underwriting (UK) Ltd registered in England & Wales under Company number 07889205 and whose registered address is Epsilon House, West Road, Ipswich IP3 9FJ. Precision Underwriting (UK) Ltd is an appointed representative of Barbarus Limited who are authorised and regulated by the Financial Conduct Authority under firm reference number 617848.

LYH Enquiry Form v4.0 Nov 17