At Kelleher Insurances, we search the market to find the best house policy to meet your needs, both in price and cover. Full Name* Email Address* Phone No*Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enter Eircode to Find AddressFind AddressAddress The property that I am insuring*I own it and live in itI own it and rent itAddress Street AddressAddress - Line two Street Address TwoAddress - Town/City Town/CityAddress - Eircode EircodeI require buildings (rebuild cost) sums insured of* I require contents sum insured of* All risks required*NoYesList Specified Items & Value*Unspecified sum insured* House of Standard Construction Yes No Describe type of constructionYear of Construction Number of Bedrooms Any Flat Roof Yes No % of house Security Alarm Yes No I have relevant security locks Yes No Monitored to Central Station Yes No Heating TypeSelectOilGasElectricRenewableI have two or more working smoke detectors* Yes No Existing Insurer Current Renewal Date DD slash MM slash YYYY Any Claims in last 5 years*Please SelectYesNoNumber of claims*12345678910Year of last claim*2014201520162017201820192020Cause of claim*Water damageLightingStormTheftFireOtherPlease Specify* Amount claimed* Staus*OutstandingClosed2nd ClaimYear of last claim*2014201520162017201820192020Cause of claim*Water damageLightingStormTheftFireOtherPlease Specify* Amount claimed* Staus*OutstandingClosed3rd ClaimYear of last claim*2014201520162017201820192020Cause of claim*Water damageLightingStormTheftFireOtherPlease Specify* Amount claimed* Staus*OutstandingClosed4th ClaimYear of last claim*2014201520162017201820192020Cause of claim*Water damageLightingStormTheftFireOtherPlease Specify* Amount claimed* Staus*OutstandingClosed5th ClaimYear of last claim*2014201520162017201820192020Cause of claim*Water damageLightingStormTheftFireOtherPlease Specify* Amount claimed* Staus*OutstandingClosed6th ClaimYear of last claim*2014201520162017201820192020Cause of claim*Water damageLightingStormTheftFireOtherPlease Specify* Amount claimed* Staus*OutstandingClosed7th ClaimYear of last claim*2014201520162017201820192020Cause of claim*Water damageLightingStormTheftFireOtherPlease Specify* Amount claimed* Staus*OutstandingClosed8th ClaimYear of last claim*2014201520162017201820192020Cause of claim*Water damageLightingStormTheftFireOtherPlease Specify* Amount claimed* Staus*OutstandingClosed9th ClaimYear of last claim*2014201520162017201820192020Cause of claim*Water damageLightingStormTheftFireOtherPlease Specify* Amount claimed* Staus*OutstandingClosed10th ClaimYear of last claim*2014201520162017201820192020Cause of claim*Water damageLightingStormTheftFireOtherPlease Specify* Amount claimed* Staus*OutstandingClosedAny additional informationFor Marketing Preferences – Please advise to agreed methods of Contact:* Email Phone SMS Please do NOT contact me Data Consent* I confirm that I give my Data Processing Consent to Kelleher Insurances to process all Data.
