Please ensure you have read the important information at the end of this form before sending itto us.
Client Name(s) / Policy/Quote Ref
Risk Address/Address of the Property to be Insured
Addressincluding
Postcode
Type of Property
1 / Is the property: Detached Semi Detached End Terrace Mid Terrace
If Other, give details
Roofing
2 / What roofing material is used?(please tick)
Water Reed/Norfolk Reed Combed Wheat/Devon Reed Long Straw Fibre Thatch
If Other, give details
3 / What is the approximate depth of the thatch?
Less than 1 metre Between 1 metre & 2 metres Greater than 2m
4 / Does the property have a 100% thatched roof? / YES NO
If No, what percentage is not thatch and what other roofing materials are used?
Heating and Chimneys
5 / Are chimneys ever used? / YES NO
If Yes,how many chimneys are there?
6 / Is/are the chimney(s) lined? YES NO
If Yes, when was the lining(s) last inspected/replaced?
7 / How is the property heated? (tick all that apply)
Central Heating Open Fires Solid Fuel Stoves Multi Fuel Stoves
If you have ticked Open Fires and/or Solid and/or Multi Fuel Stoves:
a) If the roof is less than 100% thatched are the fires/stoves situated under the area of thatched roof?
YES NO
b) Has the chimney been swept in the last 12 months? YES NO
c) What height is the top of the chimney above the ridge?(tick)
Less than 1 metre Between 1 metre & 2 metres Greater than 2metres
d) Are spark arrestors fitted to the chimney? YES NO
Fire Precautions
8 / What Fire precautions does the property benefit from?(please tick all that apply)
Fire Alarm linked to a monitoring station 60 minute Fire Barriers beneath the thatch
Extinguishers / If Yes, advise type and where kept
Fire Blanket in the kitchen / Smoke Detectors (Mains) / (Battery)

Minimum of one per floor/complying with EN/BS 14604 YESNO

Anyother precautions, please provide details
Fire Brigade
9 / How many miles is the property from the nearest Fire Station?
Less than 5 miles Between 5 & 10 miles Greater than 10 miles
Water Supply
10 / Is the property connected to the mains water supply? YES NO
11 / Are there any additional sources of water available? YES NO
(e.g. lake, swimming pool, river or stream)
If Yes, please give details including distance to property
Electrics
12 / Do you have a current and valid periodic electrical inspection report completed by a NICEIC, ECA, NAPIT, BSI or ELECSAapproved qualified electrician? YES NO
Additional Information

Important Information

The answers to all questions are important. You are required to take care to answer all questions accurately and honestly and not to omit any relevant information. If you give us incorrect or incomplete information the wrong terms may be quoted, the insurers may be entitled to reject payment of a claim or payment could be reduced. In certain circumstances your policy might be invalid, and you may not be entitled to a refund of premium.

Please also note that upon completion of this questionnaire you may be asked to provide additional information at your own expense.

Name/Signature of person completing form: / Dated:

Please tick, if you are an Agent completing on behalf of your client

Registered Address: 57 Ladymead, Guildford, Surrey GU1 1DB, United Kingdom. Registered in England No. 3007252.

Home and Legacy Insurance Services Limited is authorised and regulated by the Financial Conduct Authority.

A member of the British Insurance Brokers Association. Calls may be recorded for our joint protection, training and/or monitoring purposes.

Thatch Questionnaire July 17