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:	☐ None ☐ Ryan ☐ Towegate ☐ 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.	☐

(once you have pressed submit, you can close the form)