Data Consent* I confirm that I give my Data Processing Consent to Kelleher Insurances to process all Data. Full Name*Email Address* Phone No*Enter Eircode to Find AddressFind AddressAddress The property that I am insuring*I own it and live in itI own it and rent itAddressStreet AddressAddress - Line twoStreet Address TwoAddress - Town/CityTown/CityAddress - EircodeEircodeI require buildings sums insured of*House of Standard ConstructionYesNoDescribe type of construction Year of ConstructionAny Flat RoofYesNo% of houseSecurity AlarmedYesNoMonitored to Central StationYesNoWith accidental damage*YesNoI require contents sum insured of*All risks required*NoYesList Specified Items & Value* Unspecified sum insured*Total specified sum insured*Existing InsurerCurrent Renewal Date 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 information For Marketing Preferences – Please advise to agreed methods of Contact:* Email Phone SMS Please do NOT contact me
