Name of Proposer: Contact Name:
Address 1: Address 2:
County: Postcode:
Email Address: Telephone Number:
Location of Premises to be insured:
Name of Owner (if not Proposer):
Interest of Owner in the Premises (if not Proposer):
Name and address of architect:
Is the construction contract signed under seal? Yes No
Name and address of Main Contractor:
Does the Owner/Proposer intend to retain or sell on their interest in the Premises?
Name of the company/building control providing regulatory inspections services on this building:
