• Proposal Form

    Non-Standard Leisure Home Insurance

    For Non-Standard property used as Leisure Home of the Insured in the UK

  • It is important that all questions in this proposal are answered accurately. Please provide separately any other information you think might be material to our understanding of your requirements.

    Your completing this form in detail will enable us to match your insurance to your needs.

     

  •   FCA Reg No Company Name Contact Name Phone Number Email
    Details
  • Your Information

  •   Details
    Title
    First Name
    Surname
    Date of Birth
    Occupation
    Length of residency in UK
  •   Details
    Title
    First Name
    Surname
    Date of Birth
    Occupation
    Length of residency in UK
  •  -

  •  -  - Pick a Date
  • Bordengate Insurance and BGi.UK are trading styles of H J Roelofs (UK) Ltd which is authorised and regulated by the Financial Conduct Authority (FCA). Our Financial Services register number is 307129. Company Registration no. 3464365

    Terms & conditions on www.bgi.uk.com and available on request.

  • Property Details

  •   Details
    Type of Property
    Construction Type
    Name of Manufacturer
    Model name or Property Description
    Chassis / Serial Number / ID Reference
    Year of Manufacture
    Length (Feet)
    Width (Feet)
  • Please Note: If your Property is over 15 years old special conditions may be applied to your Policy.

  •   Yes No
    Electric
    Gas (Mains)
    Oil
    Solid Fuel
    Bottled Gas
  • Bordengate Insurance and BGi.UK are trading styles of H J Roelofs (UK) Ltd which is authorised and regulated by the Financial Conduct Authority (FCA). Our Financial Services register number is 307129. Company Registration no. 3464365

    Terms & conditions on www.bgi.uk.com and available on request.

  • Park Details:

  •   Yes No
    NCC Registered Park
    Gold Shield Registered Park
    David Bellamy Conservation Awarded Park
    Unregistered Permanent Residence Park
    Farm
    Private Land (Permanent Residence)
    Private Land with Construction Works
    Other
  • Bordengate Insurance and BGi.UK are trading styles of H J Roelofs (UK) Ltd which is authorised and regulated by the Financial Conduct Authority (FCA). Our Financial Services register number is 307129. Company Registration no. 3464365

    Terms & conditions on www.bgi.uk.com and available on request.

  • Insurance Cover Required

  • Buildings & Contents

  • Additional cover away from Home

  •   Yes No
    Anywhere in Europe
    Anywhere within the Rest of the World for a maximum of 30 days
  • If  Yes to either option in question above please specify the additional cover you would like below:

  • Unspecified Cover

  • Specified Cover

  •   Yes No
    Accidental Damage when Let (Up to a limit of £5000)
    Malicious Damage by hirers (Up to a limit of £2500)
  •   Yes No
    30 consecutive days
    3 consecutive days between 31st October - 31st March
  •   Yes No
    You have complied with and will continue to comply with the conditions of the Manufacturer's Owner's Handbook and Warranty Obligations
    The base has been installed in accordance with the Manufacturer's Siting and Warranty Obligations
  • Bordengate Insurance and BGi.UK are trading styles of H J Roelofs (UK) Ltd which is authorised and regulated by the Financial Conduct Authority (FCA). Our Financial Services register number is 307129. Company Registration no. 3464365

    Terms & conditions on www.bgi.uk.com and available on request.

  • Declarations

  • Important: No list of questions can be exhaustive and we must ask you to consider carefully whether there is any information not given herein which could influence our acceptance of this proposal. Material information includes any special, unusual or otherwise relevant features of the property, its occupation or its location which might make losses more likely to happen or to be more serious or costly than might otherwise be anticipated. You should disclose any information which might be relevant. Failure to do so could invalidate your policy.

    Declaration: I declare that to the best of my knowledge and belief that the answers herein are true and that all material information has been fully disclosed. I agree that this proposal is for insurance in the normal terms and conditions of the insurer's policy and shall be incorporated into and form part of the insurance contract.  I undertake to inform insurers, in writing (email included) and immediately, of all changes before and during the policy period.

    Notice: The information provided on this proposal form will be made available to any other insurer, broker or authority who might make an enquiry regarding the veracity of statements made regarding the information provided in any proposal form, claim form or other document or any statement made orally or electronically.

  •  -  - Pick a Date
  • One of our Omar Insurance team members will contact you on receipt of your form.

  • To complete your application, email Omarinsurance@BGi.uk.com with the following and enclose the ID number you will receive on submission of the form:

    1. A photo of the exterior of your home
    2. A photo of the interior of your home
    3. Any additional material information

    Alternatively you may wish to post the documents to:

    Omar Insurance
    Portwell House
    26 Market Place Faringdon
    Oxon
    SN7 7HU

    Please ensure you quote the ID number you will receive on submission of your form with any and all further correspondence.



  • Bordengate Insurance and BGi.UK are trading styles of H J Roelofs (UK) Ltd which is authorised and regulated by the Financial Conduct Authority (FCA). Oour Financial Services register number is 307129. Company Registration no. 3464365

    Terms & conditions on www.bgi.uk.com and available on request.

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