Home Contents Insurance Application Form

Home Contents Insurance

Application Form

Peace of mind at an affordable cost

It is important that the sum insured chosen (in round sums of £1000) is sufficient to

cover the full replacement cost of all your household goods and personal effects.

Underwritten by Allianz Insurance plc. Registered in England number 84638. Registered office:

57 Ladymead, Guildford, Surrey, GU1 1DB, United Kingdom. Allianz Insurance plc is authorised

by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and

the Prudential Regulation Authority. Allianz Insurance plc is on the Financial Services Register,

registration number 121849.

PLEASE USE CAPITAL LETTERS WHEN FILLING IN THIS FORM

Are you a tenant of North Ayrshire Council?

Your Full Name (Mrs/Ms/Miss/Mr/other)

(Joint tenants + Co-habitees must be named)

Address

Post Code

Telephone no. Date of Birth

Email address

Contents Sum Insured required £ __________________

Do you require extended Accidental Damage Cover (at extra cost)? Yes

Where did you hear about this insurance scheme?

Personal Details

For Office Use Only

Premium £

Input Date / / Sent Date / /

PLEASE ANSWER ALL THE QUESTIONS BELOW.

WE CAN ONLY CONSIDER YOUR APPLICATION ONCE ALL

THESE QUESTIONS HAVE BEEN ANSWERED.

(Please tick the correct box in answer to the questions below)

1. Is your home self-contained with its own separate lockable front door?

2. Is this property your permanent home and occupied only by yourself and

members of your immediate family normally living with you?

3. 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

(use a separate sheet if more space is needed).

4. Do you ever leave your home empty or unattended for more

than 35 days in a row?

5. Is your home used for running a business?

6. Have you or anyone living with you ever been refused insurance or

had special terms imposed by an insurer?

If you have answered YES to any of the above questions, please give more details below

(use a separate sheet if more space is needed).

7. Have any incidents occurred in the last three 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

(use a separate sheet if more space is needed)

Date(s) of incident(s)

What caused the loss (theft, water damage etc.)?

Value of goods lost or damaged?

Were you insured at the time?

If so, how much did the insurers pay in settlement of the claim?

Since the loss have all items which were damaged/lost been replaced?

8. Do you or anyone living with you have any unspent criminal convictions other

than motoring convictions, or have any prosecutions pending?

If you have answered YES to the above question, please tell us:

Date of conviction or charge?

Nature of offence?

Penalty received (fine, custody etc.)?

Your age at the time?

Yes No

To be answered by the applicant

Declaration

PLEASE READ THE DECLARATION BELOW CAREFULLY BEFORE SIGNING IT

(to be completed after entering the information requested opposite and overleaf)

1. I/We agree to advise the Company if any of the answers given above should change.

2. I/We declare that all questions have been fully completed and the answers are true and

correct to the best of my/our knowledge and belief. Failure to answer truthfully and

completely may mean that your policy becomes invalid or does not operate in the event

of a claim. If you are in any doubt please contact Housing Services, North Ayrshire

Council, Cunninghame House, Irvine, KA12 8EE or telephone: Home Contents Insurance

Team on 01294 324611.

3. I/We declare that we understand the contents of this completed application including

the important information for applicants at the start of this form.

4. I/We declare that Allianz Insurance plc may contact my/our present insurer for further

information.

5. I/We undertake to pay the premium when called upon to do so.

6. I/We understand that the information on this form and information about any incident

I/we may give details of may be passed to IDS Ltd so that they can make it available to

other insurers. I/We also understand that, in response to any searches that may be made

in connection with this application or any incident I/we have given details of, IDS limited

may pass my/our insurers information it has received from other insurers about other

incidents involving anyone insured under the policy.

Special Note

If during the period of your insurance cover, your home is likely to be unoccupied (e.g.

through hospitalisation, extended holiday) for more than 35 days in a row you must contact

the Company to establish whether cover can continue.

Signature(s) Signature(s)

Date

This document is available in large print and Braille if required.

Joint tenants should both sign unless

they are married to each other

Joint tenants should both sign unless

they are married to each other

Important Notice

ata Protection Act – Information Uses

For the purposes of the Data Protection Act 1998, the

Data Controller in relation to any personal data you supply

s Allianz Insurance plc.

nsurance Administration

The insurer, its associate companies and agents may use

the personal data that you supplied for the purpose of

nsurance administration. This data may be disclosed to

the insurers, your intermediary and regulatory bodies for

the purpose of administering and regulating your

insurance.Your information may also be used for offering

renewal, conducting research, statistical purposes and

crime prevention. We may share these details with other

insurance organisations (such as Loss Adjustors, or

Investigators) to help handle claims. Your personal details

may be transferred to countries outside the EEA. They will

at all times be held securely and handled with the utmost

care in accordance with all principles of the UK law. We

will store your details but will not keep them for longer

than necessary. Under the terms of the Data Protection

Act 1998 you are entitled to a copy of all the information

we hold about you for which we may charge you a fee.

Sensitive Data

In order to assess the terms of the insurance contract or

administer claims which arise, the insurer may need to

collect data which the Data Protection Act defines as

sensitive (such as medical history or criminal convictions).

By proceeding with this application you will signify your

consent to such information being processed by the

insurer or its agents.

Fraud Prevention, Detection and Claims History

Insurers pass information to the Claims Underwriting

Exchange register, run by Insurance Database Services Ltd

(IDS Ltd). The aim is to help us check information provided

and also to prevent fraudulent claims. We may at any time

search the register including when we deal with your

request for insurance. Under the conditions of your policy

you must tell us about an incident (such as fire or a theft)

which may or may not give rise to a claim. When you tell

us about an incident we will pass information relating to it

o the database. We can supply more information on the

database if you request it. You should show this notice to

anyone who has an interest in property insured under this

olicy. Allianz Insurance plc may seek information from

ther insurers and information agencies to check the

nformation you may have supplied and Allianz Insurance

plc may provide the information you have supplied to

other insurers for the same purpose.

Claims History

● Under the conditions of your policy you must tell us

about any insurance related incidents (such as fire,

water damage, theft or an accident) whether or not

they give rise to a claim. When you tell us about an

incident we will pass information relating to it to a

database.

● We may search these databases when you apply for

insurance, in the event of any incident or claim, or at a

time of renewal to validate your claims history or that

of any other person or property likely to be involved in

the policy or claim.

Law Applicable to Contract

The law in the country in which you reside at the date of

contract will apply.

Allianz Insurance plc.

Registered in England number 84638. Registered office: 57 Ladymead, Guildford, Surrey GU1 1DB, United Kingdom.

Allianz Insurance plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority

and the Prudential Regulation Authority. Allianz Insurance plc is on the Financial Services Register, registration number 121849.

128630_v2_CRYSTAL TCI_02/16

Home Contents Insurance

North Ayrshire Council does not insure your furniture, belongings or

decorations against theft, fire, vandalism and burst pipes and other

household risks.

You need to take out your own insurance. Under a special scheme arranged

with Allianz Insurance plc, it’s easy for you to protect your belongings.

You can arrange your insurance at a special low cost rate.

The scheme is open to all the tenants.

Payment of the premium

Premiums are calculated on a weekly, fortnightly and monthly basis and can be paid in a number

of ways (please see below):

When you are accepted onto the scheme you will receive a welcome letter which will advise you of

the amount you need to pay and when the first payment has to be made.

• Interactive Voice Response. (0845) 6030593 (24-hour) payment will be accepted. Details are

entered using a touch-tone telephone and by response you will be given a verbal receipt number.

• Internet Payments. Via the ‘Online Services’ option on the North Ayrshire Council web site.

• Telephoning your Area Housing Office or Housing Headquarters and using your credit/debit card.

• By post to your Area Housing Office.

• By Banker’s standing order.

• Plastic payment card for use at your Area Housing Office, Post Office or Paypoint/Payzone outlet.

• By Direct Debit.

Insurance for your furniture, TV, clothing, carpets, electrical items

and general household goods

When you take out this insurance most of your household goods and contents will be insured

in your home. The insurance also covers replacement of external locks if your keys are lost or

stolen and the contents of your freezer. There is also cover for personal liability, and cover for

damage to your landlords fixtures and fittings which you may be legally responsible for under the

terms of your tenancy agreement. Full details of the policy cover applying are available on request.

Insurance against fire, theft, vandalism, water damage and other

household risks

These are examples of the types of risk your contents will be insured for.

Full details of the policy cover applying are available on request.

Extended accidental damage option

You may choose to take out extended accidental damage cover at an extra cost.

‘New-for-Old’ insurance

All your home contents are covered by the policy on a ‘new for old’ basis, with the exception

of linen and clothing which will be replaced at their current cost, less an amount for wear and

tear. When you are working out the cost of your insurance, you will need to work out how

much it will cost to replace the full contents.

If you underinsure your contents, any claim

payment will be reduced to the same proportion as the contents sum insured bears to

the full replacement cost.

Special low minimum sums insured

The lowest amount that can be insured is:

● £6,000 if you are over the age of 60.

● £9,000 for all other people.

Cost of Insurance

You can work out the cost of your insurance by following these easy steps:

1. Use the do-it-yourself valuation sheet opposite to work out how much cover you need.

2. Now refer to the premium table on pages 5 & 6 to select the premium you will pay.

3. Return completed form to:

North Ayrshire Council

Housing Services

Cunninghame House

Irvine

KA12 8EE

Home Contents Insurance

Rooms/Items:

Items in living room 1. e.g. TV, Radio, Video, Hi-Fi, Satellite

Equipment, Computer, Suite, Carpet, Tables, Other Furniture,

CD’s, Videos, Light Fittings, Books, Ornaments, Curtains etc.

Items in living room 2. e.g. Dining Table, Chairs, Sideboard,

Other Furniture, Carpets, Curtains, Light Fittings, Ornaments etc.

Items in kitchen. e.g. Cooker, Washer, Fridge, Freezer,

Pots & Pans, Crockery, Table, Chairs, Floor Covering, Light Fittings,

Ornaments, Microwave, Toaster, Kettle, Other Electrical Items etc.

Items in bedroom 1. e.g. Bed, Bedroom Furniture, Carpet,

Curtains, Light Fittings, Clock, Bedding, Jewellery, Ornaments,

Games, Toys, Towels, Computer, Clothing etc.

Items in bedroom 2. e.g. Bed, Bedroom Furniture, Carpet,

Curtains, Light Fittings, Clock, Bedding, Jewellery, Ornaments,

Games, Toys, Towels, Computer, Clothing etc.

Items in bedroom 3. e.g. Bed, Bedroom Furniture, Carpet,

Curtains, Light Fittings, Clock, Bedding, Jewellery, Ornaments,

Games, Toys, Towels, Computer, Clothing etc.

Other items. e.g. Vacuum Cleaner, Tools, Lawnmower, Gardening

Equipment etc.

Total Value

Do-it-yourself valuation of your household contents

Most people find that their household contents are worth more than they think.

Please use this page to help value the contents of your property but first read the section on

‘New for Old’ insurance on page 2.

Add up the Total Value column and round the total figure up to nearest £1,000,

then enter this figure on the application form.

Please keep this sheet for future reference

Home Contents Insurance

How to apply

Complete the form at the back of this booklet. Make sure that you answer all the questions

and sign the declaration. If you want any help filling in the form, please contact the House

Contents Insurance Team on 01294 324611. Once you have completed the form, detach it and

post it to:

North Ayrshire Council, Housing Services,

Cunninghame House, Irvine, KA12 8EE.

Keeping up the payments

• To make sure that you are always covered you must keep up to date with your

payments.

• You will not be allowed to make a claim unless your payments are up to date.

• Your insurance may be cancelled if you don’t keep your premiums up to date.

Start date

• Cover will start as soon as your application has been accepted.

• A policy and schedule detailing the sum insured, premium and cover will be sent to you.

Special Notes

• If during the period of your insurance cover your home is likely to be unoccupied (e.g.

through hospitalisation, extended holiday) for more than 35 days in a row, or if there is any

change in your risk circumstances such as a change of address, you will have to advise the

House Contents Insurance Team on 01294 324611.

• Remember, it is your responsibility to establish whether cover can continue and that the sum

insured is sufficient to cover all your household items and personal effects.

• You do need to have a clear rent account to be accepted on the scheme.

North Ayrshire Council urges all tenants to take out home contents insurance,

either through our special scheme or by making your own arrangements.

If you wish to apply complete the application form attached.

Home Contents Insurance

All premiums include Insurance Premium Tax (IPT) at the current rate.

Cost of insurance

You may wish to use the do–it–yourself valuation sheet on page 3, to help you work out

how much cover you need.

PREMIUMS FOR TENANTS AGED UNDER 60

Weekly Payment

Standard Cover

Sum Standard inc Extended

Insured Cover Acc Damage

£9,000 £0.84 £1.10

£10,000 £0.94 £1.23

£11,000 £1.03 £1.35

£12,000 £1.13 £1.47

£13,000 £1.22 £1.60

£14,000 £1.31 £1.72

£15,000 £1.41 £1.84

£16,000 £1.50 £1.96

£17,000 £1.60 £2.09

£18,000 £1.69 £2.21

£19,000 £1.78 £2.33

£20,000 £1.88 £2.45

£21,000 £1.97 £2.58

£22,000 £2.06 £2.70

£23,000 £2.16 £2.82

£24,000 £2.25 £2.95

£25,000 £2.35 £3.07

£26,000 £2.44 £3.19

£27,000 £2.53 £3.31

£28,000 £2.63 £3.44

£29,000 £2.72 £3.56

£30,000 £2.82 £3.68

£31,000 £2.91 £3.80

£32,000 £3.00 £3.93

£33,000 £3.10 £4.05

£34,000 £3.19 £4.17

£35,000 £3.29 £4.29

Home Contents Insurance

Cost of insurance

You may wish to use the do–it–yourself valuation sheet on page 3, to help you work out

how much cover you need.

PREMIUMS FOR TENANTS AGED 60 AND OVER

All premiums include Insurance Premium Tax (IPT) at the current rate.

Weekly Payment

Standard Cover

Sum Standard inc Extended

Insured Cover Acc Damage

£6,000 £0.39 £0.61

£7,000 £0.46 £0.71

£8,000 £0.52 £0.81

£9,000 £0.59 £0.91

£10,000 £0.65 £1.01

£11,000 £0.72 £1.11

£12,000 £0.78 £1.21

£13,000 £0.85 £1.32

£14,000 £0.91 £1.42

£15,000 £0.98 £1.52

£16,000 £1.04 £1.62

£17,000 £1.11 £1.72

£18,000 £1.17 £1.82

£19,000 £1.24 £1.92

£20,000 £1.30 £2.02

£21,000 £1.37 £2.12

£22,000 £1.43 £2.23

£23,000 £1.50 £2.33

£24,000 £1.56 £2.43

£25,000 £1.63 £2.53

£26,000 £1.69 £2.63

£27,000 £1.76 £2.73

£28,000 £1.82 £2.83

£29,000 £1.89 £2.93

£30,000 £1.95 £3.03

£31,000 £2.02 £3.14

£32,000 £2.08 £3.24

£33,000 £2.15 £3.34

£34,000 £2.21 £3.44

£35,000 £2.28 £3.54

This is a Policy Summary only and does not

contain the full terms and conditions of the

contract. It does not form part of the

contract between you and us. Full terms

can be found in the Policy Wording, a copy

of which is available on request.

What is Tenants Contents Insurance and

what does it cover me for?

Tenants Contents Insurance is a tenants

insurance policy that provides standard

contents cover for your belongings (not

used for business purposes) within your

home.

What happens if I take out cover and

then change my mind?

The policy provides you with a 14 day

reflection period to decide whether you

wish to continue. This is subject to certain

terms, full details are shown in the full

policy wording which is available on request.

How do I notify a claim under Tenants

Contents Insurance

For a claim form please contact the House

Contents Insurance Team on 01294 324611.

How do I make a complaint about my

Tenants Contents policy?

If you have a complaint about anything other

than the sale of the policy please contact

our Customer Satisfaction Manager at:

Allianz Insurance Plc

2530 The Quadrant

Aztec West

Almondsbury

Bristol

BS32 4AW

Phone: 0800 072 4760

Fax: 01483 529717

Email: [email protected]

If we are unable to resolve the problem we

will provide you with information about the

Financial Ombudsman Service.

Full details of our complaints procedure may

be found in your policy documentation.

Using our complaints procedure or referral

to the Financial Ombudsman Services does

not affect your legal rights.

Would I receive compensation if Allianz

Insurance plc were unable to meet its

liabilities?

In the event that Allianz Insurance plc is

unable to meet its liabilities you may be

entitled to compensation from the Financial

Services Compensation Scheme (FSCS).

Further details are in your policy wording.

Contents

The policy covers your household goods and

personal belongings whilst they are within

your home, against unexpected loss or

damage, for example by fire or theft.

Policy Summary

Allianz Insurance plc. Registered in England number 84638. Registered office: 57 Ladymead, Guildford, Surrey GU1 1DB, United Kingdom.

Allianz Insurance plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the

Prudential Regulation Authority. Allianz Insurance plc is on the Financial Services Register, registration number 121849.

Full details can be found in the Policy Cover

section of your policy – the key exclusions

and limitations are set out below.

We will not cover you for theft if your home

is lent, let or sublet, unless force is used to

get into or out of your home.

•

A limit of £250 applies in respect of

Personal Money

•

A limit of £500 applies in respect of cover

for each credit card

•

A limit of £2000 applies in respect of

theft of your belongings from your

outbuildings

•

A limit of £1000 applies in respect of

tapes, discs or record discs of any kind to

do with home entertainment equipment

•

Tenants improvements that you make as

a tenant are covered up to £2000.

Cover under section T will only apply if you

have paid the additional premium to include

this section.

Under the extended accidental

damage extension (Section T) you are

not covered for:-

•

Accidental damage caused by pets

•

Accidental damage to clothing

On what basis are claims settled?

We will pay to replace property or

belongings lost or destroyed and we will

pay to repair damaged items.

We will make a deduction for wear and tear

for claims on clothes or household linen.

We will pay for the damaged items that are

part of a set or suite but we will not pay for

the other pieces which are not damaged.

This is not a maintenance contract. This

means that wear and tear or anything that

happens gradually is not covered.

Unoccupancy

The policy excludes certain loss or damage

if no-one is living at the property for more

than 35 days in a row. If this applies to

you, you will not be covered for theft,

malicious people or water leaking from

pipes and heating installations.

Home Contents Insurance

IMPORTANT INFORMATION FOR APPLICANTS

• This form details the information on which the contract of insurance is based.

• You must ensure that all questions have been fully completed

and the answers are true and

correct to the best of your knowledge and belief.

• If there are any inaccuracies or omissions let the Administrator know immediately.

• FAILURE TO DO THIS MAY MEAN THAT YOUR POLICY BECOMES INVALID OR DOES NOT

OPERATE IN THE EVENT OF CLAIM

• You should keep a copy of all information and correspondence you supply to us in connection

with your application. A copy of this form will be supplied on request for a period of three

months after its completion.

• A copy of the Policy Wording is available on request.

• You are not covered until your application has been accepted by Allianz Insurance plc or

your Administrator.

Please detach and return the whole completed Application form to:

North Ayrshire Council

Housing Services

Cunninghame House

Irvine

KA12 8EE