LANDLORD LEGAL AND RENT PROTECTION INSURANCE

STATEMENT OF FACT

The information you have supplied to us is used to determine whether we will accept your insurance quotation, and if so, the premium to be charged and the terms, conditions and exclusions to be applied. You must ensure to the best of your knowledge and belief that all the information you provide to us is correct and accurate. Failure to disclose correct and accurate information may result in your insurer refusing to pay claims and/or void this insurance.

POLICY NO:

INSURED:

CORRESPONDENCE ADDRESS:

INSURED ADDRESS:

MONTHLY RENTAL:

PERIOD OF INSURANCE:

Both days inclusive, local standard time, at the address of the Insured

I confirm that I: