Please see the ‘Contents Checklist’ and ‘Rebuilding Cost Calculator’ links on our Document Centre page for assistance with estimating your contents and rebuilding cost sums insured.

You can submit an enquiry on-line by completing the form below and clicking the 'send' button. Alternatively, you can print out this form by clicking the 'print' button and fax it us. Fields marked with an asterisk must be completed.

Full Name*		Age*
Address*
Post Code*		Occupation*
Email		Tel No.*

Section 1 - About your home
1.	Is your home of standard construction?*	Yes    No
2.	Is this your main residence?*	Yes    No
3.	Is any part of the property used for business?* If needed, use 'Additional Information' text box below.	Yes    No
4.	Do you have any planned or ongoing renovations? If needed, use 'Additional Information' text box below.	Yes    No
5.	Is your home free from signs or history of cracks, subsidence or flooding?*	Yes    No
6.	Are accessible windows, fanlights, skylights fitted with key operated locks?*	Yes    No
7.	Are French / patio doors fitted with key operated locks top and bottom?*	Yes    No
8.	Are external doors fitted with 5 lever mortice deadlocks or similar standard?*	Yes    No
9.	Do you have a safe or strongroom?*	Yes    No
10.	Do you have a maintained alarm?*	Yes    No
	If yes, please specify type     Select Alarm type... Bells only Central Station Redcare
11.	What type of property is your home*	Detached Semi Detached Terraced
12.	What date (approximately) was your property built*
13.	How many bedrooms does your home have*

Section 2 - Sums To Be Insured
A	What is the rebuilding cost of your home? (please remember this is not the same as your propertyís market value)	£
B	CONTENTS: What is the total value of your contents - excluding C and D below (please see our contents checklist for assistance)	£
C	FINE ART: What is the total value of your;
	Fine art or antiques (including pictures, books, furniture, rugs)	£
	Gold, Silver & Plate or Precious Metals	£
	Others (e.g. collections) - Please describe	£
D	VALUABLES: What is the total value of your;
	Jewellery & Watches	£
	Furs	£
	Jewellery & Watches kept only in a safe within the home	£
	Jewellery & Watches kept only in a bank or safe deposit	£
Section 3 - Additional information
Please provide details of all claims in the last 5 years other than Motor Insurance
What level of excess do you require   £ Select excess... 150 (minimum) 250 500 1000 Other   Other  £
Do you require Annual Travel cover (maximum age up to and including 65)? Yes    No
Do you require a quotation for a second home/holiday home? Yes    No
Please give any additional information to assist us in providing a quotation below:
Who is your current Insurer & what is the Premium?
Where did you hear of SmithGreenfield
SouthWest advert NorthWest advert Kew Magazine advert Elmbridge Magazine advert Country House Magazine advert RAC memberís Journal advert The Green advert The Hill advert Art Quarterly advert Art Fund memberís handbook English Home advert English Garden advert Motorsport advert Referred by friend Referred by insurer Website search Other magazine advert (please state) Yell.com Surrey Guardian Exclusively Surrey Richmond Magazine Other (please state)