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*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enter 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 (rebuild cost) sums insured of*I require contents sum insured of*All risks required*NoYesList Specified Items & Value* Unspecified sum insured*House of Standard ConstructionYesNoDescribe type of construction Year of ConstructionNumber of BedroomsAny Flat RoofYesNo% of houseSecurity AlarmYesNoI have relevant security locksYesNoMonitored to Central StationYesNoHeating TypeSelectOilGasElectricRenewableI have two or more working smoke detectors*YesNoExisting 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 Data Consent* I confirm that I give my Data Processing Consent to Kelleher Insurances to process all Data.
