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Please supply the following information :
Fields marked with a * are mandatory.

Full name of Insured:*
Address 1:*
Address 2:*
Address 3:
Post Code:*
Email Address:
Telephone:
Excess Level:*The excess you select must be the same as the excess shown in your building insurer's policy. It cannot be greater or lesser.
Residential£1000   £1500
Commercial£1000   £1500   £2000   £2500

Please confirm the following is correct:

You confirm in respect of subsidence, heave or landslip you have not been refused or declined insurance on the insured premises or had any policy covering the insured premises cancelled or had special terms or conditions applied because of subsidence, heave or landslip Yes*

The insured premises is free from any sign of damage by subsidence, heave or landslip Yes*

No part of the insured premises has been underpinned or had any other remedial work carried out in connection with subsidence, heave or landslip Yes*

Services for UK based residents and businesses only

Howe Maxted Group Limited, trading as Howe Maxted Group, is an independent intermediary and authorised and regulated by the Financial Services Authority and is entered on the FSA register (www.fsa.gov.uk/register/) under reference 131690

Registered Address: Tubs Hill House, London Road, Sevenoaks, Kent TN13 1BL
Company Registration No: England 1854813

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