House Online Submission Form "*" indicates required fields Proposer’s Personal DetailsName* Address* Eircode Date of Birth* DD slash MM slash YYYY Occupation* First Time Buyer Yes No Contact No*Email* Any Current / Previous Policies with us* Yes No Is there a Joint Proposer on Property* Yes No Joint Proposer’s Personal DetailsName* Date of Birth* DD slash MM slash YYYY Occupation* Risk DetailsRisk Address (if different) Eircode Type of Dwelling*Please ChooseDetachedSemi-DetachedBungalowTerracedEnd of TerraceApartmentType of Occupancy*Please ChooseOwner OccupiedRentedUnoccupiedHoliday HomeNo. of Occupants Type of TenantPlease ChooseFamilyCoupleSingle ProfessionalStudent(s)Year Built* Standard Construction* Yes No Please specify materials used in construction of dwelling Standard Roof* Yes No Please specify % of roof that is not standard and materials used in construction of Roof No. of Bedrooms* No. of Bathrooms* Type of Heating*Please ChooseOilElectricSolid FuelStorage HeatersMixtureGasAir to WaterSolarNo. of Paying Guests Listed Building / Basement Yes No Ever Held Insurance on this Property* Yes No Further DetailsPrevious Insurer Renewal Date DD slash MM slash YYYY No. of Claims Free Years under PolicyPlease Choose0 Years1 Years2 Years3 Years4 Years5 Years or moreMortgage on Property Yes No Mortgagor Name & Address Cover DetailsRebuild Buildings Sum Insured* Contents Sum Insured* Accidental Damage Required Yes No Cover Date DD dash MM dash YYYY Specified ItemsItem 1 € Item 2 € Item 3 € Item 4 € Valuation Available for Specified ItemsYesNoUnspecified Items Additional InformationIs property unoccupied for long periods of time? (more than consecutive 30 days)* Yes No Is property always kept in a good state of repair?* Yes No Is property under any form of construction or renovation?* Yes No Is there any business activity carried out in or around this property?* Yes No Is property within 100 metres of river, stream, sea or other watercourse?* Yes No Does the property have any history of flooding, subsidence or landslip?* Yes No Has property been monitored, surveyed or underpinned for subsidence/landslip?* Yes No Are all external windows and doors fitted with mortice security locks?* Yes No Are smoke detectors fitted?* Yes No Is the property fitted with a working alarm system?* Yes No Is it connected to a central monitoring station? Yes No Claims HistoryAny Claims in last 5 years?* Yes No Please specify when & incident details: Additional InformationThe above information was provided by: Please upload supporting documentationMax. file size: 32 MB.* please note we accept .pdf - .jpg - .png files onlyI confirm that neither Proposer(s) nor Occupant(s) of the premises have:* By ticking this box, I confirm that neither Proposer(s) nor Occupant(s) of the premises have:*• had insurance refused, declined or special terms imposed; • been cautioned, charged or convicted of any criminal offense, or any other offense involving dishonesty of any kind, within the past 7 years (excluding driving offenses under the Road Traffic Acts); • been declared bankrupt.By ticking this box, I confirm that I have answered all questions honestly and with reasonable care to ensure all responses are accurate to the best of my knowledge. If I have any reason to doubt the accuracy of the information provided, I shall contact Mannion Insurances immediately. I am aware that any negligent or fraudulent misrepresentation could invalidate or affect my policy and/or lead to a policy cancellation.* By ticking this box, I confirm that I have answered all questions honestly and with reasonable care to ensure all responses are accurate to the best of my knowledge. If I have any reason to doubt the accuracy of the information provided, I shall contact Mannion Insurances immediately. I am aware that any negligent or fraudulent misrepresentation could invalidate or affect my policy and/or lead to a policy cancellation.*Consent* By clicking Submit, I/We consent to Mannion Insurances Terms of Business & Privacy Statement which can be found here .* IMPORTANT: Cover does not commence until formally confirmed by a member of our staff.CAPTCHA