Your insurance

1. Do you wish to insure the Contents of your home? Yes     No
2. Do you wish to reduce your premium by paying an agreed amount of each claim other than the standard excess applicable for Catastrophe Perils?
   If yes, please select amount. Yes     No
   
   
   Standard of 2%
   
   
   3%
   
   
   4%
   
   
   5%

Section 1. Building

1. Do you require this cover? Yes     No
2. What is the rebuilding cost of your home?

   (NB docks, jetties, piers, seawalls or similar waterside structures are excluded unless specifically requested and accepted by the Company)

3. What is the approximate area of your home in square feet?
4. What is the age of your building i.e. when was it built? Before 1970
   1970 - 1991
   1992 or later
5. Mortgagee or other parties with a financial interest or lien on the property Name and address:

Section 2. Contents

1. Amount to be insured (do not include any unspecified valuables, clothing, jewelry or other personal belongings that will require coverage away from your home)
2. Does this represent the full cost of replacement of your home contents less an allowance for wear and tear on clothing and household linen? Yes     No

NB1 – our standard limits under this section are EC$4,000 any single item
NB2 – a list is required of any High Risk Item exceeding EC$4,000