Residential Warranty Insurance Proposal Form

Residential Warranty Insurance - Proposal Form

1. Proposer/Developer
Name of Proposer *

First Name Last Name

Address of Proposer *

Street Address
Street Address Line 2
City	State / Province
Postal Code	Country

Contact Telephone Number *
E-mail *
Requested Name to be shown on final Warranty certificate *
Name of Company/person to go on final certificate

2. The Premises to be Insured

Address to be insured *

Street Address
Street Address Line 2
City	State / Province
Postal Code	Country

Use of the premises
residential/commercial/industrial
Type/Number of premises
detached, semi-detached, terrace
Nature of your interest in premises
Owner, developer etc.
Other interested Parties (and nature of their interest)

3. Contract Details (if not yet confirmed, state TBA)
Main Contractor Name

Main Contractor Address

Street Address
Street Address Line 2
City	State / Province
Post Code	Country

If a Limited company number of years established
Company registration number
Number of years of builder/developer experience. If more than 1 year we will require evidence
Architect Name
Building Control Company/contact number
Structural Engineers Name/contact number
Project Manager Name
Is this a Design and Build Contract? *

Yes No

4. Duration of Works
Commencement Date of site clearance

Month Day Year
Date Picker Icon
Commencement Date of works

Month Day Year
Date Picker Icon
Current Build Stage
i.e. first fix
Anticipated completion date of works (if the works have already been completed, the date detailed on the building control completion)

Month Day Year
Date Picker Icon
Full details of any phasing to take place
If works have already commenced, please provide the reason that a warranty was not arranged prior to start on site.

5. Construction Methods
Foundations
strip foundations, piling, raft etc
If Piled, maximum depth of piles and reason
Frame
Stone, concrete, walls, brick, prefabricated etc
Cladding
Stone, concrete, walls, brick, prefabricated, metal etc
Roof
tiles, slates, corrugated sheets etc
Is roof flat or pitched?

Flat Pitched
If a conversion the COST of the contract works (i.e. the work undertaken on the development)
If a conversion the FULL reinstatement value of completed structure
If a conversion - age of existing structure
Years old
Total floor area (including all floors)
square metres

Number of floors when completed

Above Ground
Below Ground
Below ground	State / Province
Postal / Zip Code	Country

Details of any innovative design/materials/structural methods to be used

6. Ground Conditions: Please describe if applicable
Standard
Made up ground
Contaminated
Other ground conditions:

7. Additional Requirements
Do you require developer insolvency cover?

Yes No
If yes how much? Limit of 10% of the rebuild cost or £100,000 (whichever is the lesser for any one property)

8. Plot Details:

Details of plot numbers, floor areas & sales prices. Please include all plots including any commercial elements. Place 'X' in appropriate boxes. If you need to add more plots than 20 please attach a separate document detailing these additional plots

	SQ M	Total Rebuild Cost	Anticipated Sale Value
Plot 1
Plot 2
Plot 3
Plot 4
Plot 5
Plot 6
Plot 7
Plot 8
Plot 9
Plot 10
Plot 11
Plot 12
Plot 13
Plot 14
Plot 15
Plot 16
Plot 17
Plot 18
Plot 19
Plot 20
Total

If you need to attach a document showing further plot details please attach here
pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif allowed

10. Quotation required by date
Date quotation required by

Month Day Year
Date quotation required by Date Picker Icon

11. Additional Information
Details of any registrations the Developer has held with a warranty company previously
Details of any registrations the Builder/Contractor has held with a warranty company previously
Please provide copies of site layout plans, construction drawings etc, if available or advise in the comments box below how they can be obtained

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12 - Declaration
I have read over all of the statements and particulars given in this proposal (including any answer written for me by any other person) and I declare that to the best of my knowledge and belief they are correct and that no material fact has been omitted, misrepresented or mis-stated. I am not aware of any other circumstance likely to affect the risk. I am aware that as part of my application, Architects Certificate may carry out a credit search via Experian which may leave a foot print on my financial credit records(this is for individuals or sole traders where the application is not on behalf of a registered company).
Company name
Company Representative Name

First Name Last Name
Job Title/Position
Today's date

Day Month Year
Date Picker Icon
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Residential Warranty Insurance - Proposal Form