Apply for home contents insurance

Name

First name

Last name
Title
Date of Birth
Job title (please state if retired)
Address
Postcode
Email
Phone
Name of your domestic partner or joint proposer

First name

Last name
Title
Date of Birth
Job title (please state if retired)
Are you or any applicant over 60?

If you are over 60 the minimum amount you can insure is £6,000. If you are under 60 the minimum amount you can insure is £9000.
Are you a tenant or a leaseholder of Wigan Council?

You MUST be a council tenant to have access to this insurance scheme. If you are not a council tenant, you cannot go any further with this form.
Required start date (must be a Monday)
The amount of insurance required (your sum insured) to the nearest £1000

Remember, if you are over 60 the minimum amount you can insure is £6,000. If you are under 60 the minimum amount you can insure is £9000.
Where did you hear about the scheme?

Optional Extra Cover
Extra cover options available at an extra cost. For prices see www.wigan.gov.uk/contentsinsurance
Do you require accidental damage cover?
Do you require personal belongings cover for outside of your home?
If yes, select insurance amount required
Do you require mobility scooter/wheelchair cover?
If yes, select insurance amount required
Do you require hearing aids cover?
If yes, select insurance amount required

Is your home self-contained with its own separate lockable front door?
Is this property your permanent home and occupied only by yourself and members of your immediate family normally living with you?
Does the amount of insurance you have chosen cover the full cost of replacing all your household goods and personal belongings?
If you have answered NO to any of the above questions, please give more details below

Do you regularly leave your home empty or unattended for more than 60 days?
Is your home used for running a business?
Have you or anyone living with you ever been refused insurance, had insurance cancelled or had special terms imposed by an insurer?
If you have answered YES to any of the above questions, please give more details below

Have any incidents occurred in the last five years which would have caused you to make a claim for household contents or personal effects, whether or not you were insured at the time?
If you have answered YES to the above question, please give us the following information:
Date(s) of incident(s)
Were you insured at the time?
If so, how much did the insurers pay in settlement of the claim?

If you have had a burglary in the last five years please tell us:
How entry was gained?
What additional security has been installed since the incident? (extra locks, alarms etc.)

Have you or anyone living with you ever been convicted or charged with any offence, other than motoring offences, or is any prosecution or police enquiry pending?
If you have answered YES to the above question, please tell us:
Date of conviction or charge
Nature of offence
Penalty received (amount of fine, length of sentence etc.)
Your age at the time

Declaration
I/We (applicant and joint proposer, if applicable) declare that the information given is to the best of my/our knowledge and belief correct and complete. If the risk is accepted I/we undertake to pay the premium when called upon to do so. I/We understand that my/our information may also be disclosed to regulatory bodies for the purposes of monitoring and/or enforcing the insurer’s compliance with any regulatory rules/codes. I/We have read the 'Important Notice' document above. You must ensure that your sum(s) insured are not less than the full cost of replacing the goods; failure to do so may invalidate your policy or reduce claims settlements. Please be aware that your insurance cover will not be in place until you receive written confirmation from Wigan Council.
I/We agree

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