HOME ABOUT US OUR SERVICES LOCATION CONTACT US LINKS BUSINESS INSURANCE Commercial Insurance (Shops)        Commercial Insurance (Offices)        Liability Insurance        Property Owners Insurance        MORTGAGES Residential Property Mortgages        Commercial Mortgages        Investment Property Mortgages        Mortgage Questionnaire        FINANCIAL SERVICES        Pensions        Investments        Life Assurance / Serious Illness Cover / Income Protection        Life Assurance Quote        Mortgage Protection        HOME INSURANCE Request a Quote        House & Contents Insurance        Rented Properties Insurance        Holiday Homes (Ireland & Abroad)        HEALTH INSURANCE Vivas Health Insurance        MOTOR INSURANCE Commercial Vehicle Insurance        Motor Fleet Insurance                 Household Insurance          Please complete this form to enable us to obtain a household quotation.        Name Date of Birth [Proposer] Phone Email Address Address Type of Dwelling Select....ApartmentDetachedSemi-detachedTerracedBungalow        Is property let to tenant? Yes No Was the property built in the last 10 years? Yes No Number of years living in property          Security Details Alarm Fitted Yes No Connected to central station Yes No Smoke Detector installed Yes No          Requirements        What is the required sum insured on your building?[re-building costs]. Select...€50 000€60 000€70 000€80 000€90 000€100 000€110 000€120 000€130 000€140 000€150 000          What is the required sum insured on your contents? Select...€10 000€15 000€20 000€25 000€30 000€35 000€40 000€45 000€50 000€55 000€60 000€65 000€70 000€75 000€80 000€85 000€90 000€95 000€1000 000+          Do you require all risks cover on your valuables and personal effects outside the home? Yes No        If "Yes" state the amount of cover.        Have you had any claims in the last 5 years? Yes No        If "Yes" please give detail.        This form is for quotation purposes only and is not confirmation of a quote or insurance cover. Insurance cover will only commence on receipt of a completed proposal form, payment and written confirmation from Connolly Gaw.

Connolly Gaw Insurances Ltd is authorised by the Financial Regulator as an Authorised Adviser.        Connolly Gaw Insurances Limited - Unit F7, Nutgrove Office Park, Nutgrove Avenue, Rathfarnham, Dublin 14, Ireland          Phone: +353 (01) 216 9952        Fax: +353 (01) 298 9368        Email: info@connollygaw.com        Powered by: go2web