Church Insurance Enquiry Form

Church Insurance Enquiry Form

If you would like to enquire about insurance from Church Insurance Direct please complete the form below.
We will contact you, normally within 2 working days.

Fields marked * are compulsory

* Name of Your Church:

* Address(es) where you meet:

Address of any other buildings where you meet or have an office:

* Office: Yes No N/a
* Other meeting place: Yes No N/a

* Name of Church Contact:

* Address of Church Contact:

* Contact Telephone Number:

* Contact Email Address:

Building details required:

* Do you own a building?
Yes No

* Do you have exclusive use of a building?
Yes No

* Built with walls of brick/stone/concrete, and roofed with slate/tiles/concrete?
Yes No

* Area free from flooding?
Yes No

* Site more than 500 metres from any body of water?
Yes No

* Property in good repair?
Yes No

* Used only for church activities?
Yes No

* Does the building have a monitored alarm system installed?
Yes No

Complete if you are insuring a building:

Do you rent or loan the building to other parties?
Yes No

Does the building have any flat roof?
Yes    No
     If yes, provide approximate percentage:

Do you require Accidental Damage cover on the building?
Yes No

If there is any external non-ferrous metal (copper, lead, zinc etc.) please give an approximate value, if over £5,000:

What is the approximate age of the building?

If the building has been listed, what is the grade of the listing?

Complete if you are insuring contents:

Address where contents are stored:

Where contents are not stored in your own building or in a member of the congregation's home, are they kept in a locked room?
Yes No

Do you use equipment away from your building?
Yes No

Do you require Accidental Damage cover on your contents?
Yes No

What is the reinstatement value of your building?

What is the value of your technical equipment - PA systems, audio-visual equipment, musical instruments and desktop computer equipment?

Value of any laptops?

Value of all other movable contents?

Value of fixed contents (pipe organ, pews, pulpits, panelling etc.)?

Have you previously insured the church?
Yes    No
     If 'yes', who were the Insurance Company?

     Renewal date:

     Date Long Term Agreement expires (if any):

If you have had any claims within the last five years please give details - date, reason for claim, amount claimed:

Image verification
* To submit this form, please enter the characters you see in the image:

Please note: If for any reason the form fails to send properly, you will need to refresh this page to generate a new image. Entering the characters of a previous image will result in your submission failing.

Kingdom Bank Limited, Ruddington Fields Business Park, Mere Way, Ruddington, Nottingham, NG11 6JS, registered in England and Wales No. 4346834.
Authorised and Regulated by the Financial Services Authority.